SYSTEMS AND METHODS FOR REDUCING HEALTHCARE TRANSACTION COSTS

摘要

A centralized network can be established by contracting medical facilities and insurance providers, in which the medical facilities agree to waive all or a portion of a deductible amount owed as part of their contractual obligation with the network. The insurance providers agree to provide a credit of the premium to be paid by beneficiaries that use a contracted medical facility to receive a service for which the deductible amount is waived. Specific uses of the systems and methods disclosed can include management of a Medicare supplemental insurance network in which Part A deductibles are waived by hospitals or similar medical facilities, and premium credits are provided to beneficiaries of Medicare supplemental insurance policies who use contracted medical facilities. The cost savings and increased revenue recognized by both medical facilities and insurance providers can enable claims to be re-priced while reducing transactional costs for all parties.

主权项

1. A computer-implemented method for forming a network that reduces a cost of a healthcare transaction, comprising:
generating an agreement between a plurality of medical facilities and the network, wherein each member in the plurality of medical facilities agrees to waive at least a portion of a deductible upon performance, with the each member, of the healthcare transaction by a member of a group of insured patients; generating another agreement between a plurality of insurance providers and the network, wherein each member in the plurality of insurance providers agrees to provide a premium credit to the member of the group of insured patients upon performance of the healthcare transaction with the each member of the plurality of medical facilities; receiving, subsequent to the generating steps, a claim from the each member of the plurality of insurance providers; re-pricing the claim by subtracting the at least a portion; and issuing the premium credit to the member of the group of the insured patients associated with the claim, wherein the re-pricing is based on anticipated, increased revenue and anticipated, reduced costs for the plurality of medical facilities and the plurality of insurance providers.