32 results about "Medicare payment" patented technology

A system is disclosed that is useful by hospitals and other healthcare providers for automatically determining the best possible or maximum amount of payments a healthcare provider can lawfully expect to receive for healthcare resources which takes into account various discounts agreed upon by the healthcare provider with various private insurance companies as well as public (i.e., government) insurance providers, which administer managed healthcare plans including Medicare and Medicaid, all payments received against expected payments and a yield measurement approach for determining the providers performance at a given point in time and across various segments of its operations. In accordance with one aspect of the present invention, contracts between a healthcare provider and all private insurance companies and public insurance providers may be modeled. Various data including healthcare resources provided to patients up to a given point in time, applicable insurance company, and healthcare resource code are entered into the system. The system is able to calculate the best possible revenue that the healthcare provider can lawfully expect to receive taking into account the various discounts negotiated with the various insurance companies. Indeed, once the data is loaded, the system can provide an accurate snapshot of a healthcare provider's best possible expected revenues at any given time based upon services rendered instead of waiting until the healthcare resources have been billed out to insurance companies, patients, and third party payers. It can also provide an accurate snapshot of all payments received against those expected payments to determine yield across various segments of its operations.

The embodiments of the present invention relate to a smart phone casing and information exchange system which enables a user to carry a single system that merges the digital and telecommunications necessities of the individual with the personalized cards, membership accounts, consumer credit and / or medical insurance or health information in a single source protected both physically with a hardened case, and digitally with appropriate safeguards for electronic protection.

A data processing system for accurately calculating a discount in a medical insurance plan comprises a premiums module adapted to access data regarding the amount of premiums paid by a policyholder of the medical insurance plan for a predetermined period. A claims module is adapted to access data regarding the amount of claims paid by the medical insurance plan to the policyholder for the predetermined period, the claims module being further adapted to access data to determine if there have been any claims submitted by a policyholder which have not yet been paid, and if so to apply a set of rules to each submitted claim which has not been paid to determine if it is likely to be paid, and if the claim is likely to be paid then adding the amount of the claim to the amount of claims already paid for the predetermined period. Finally, a discount module adapted to receive data from the premiums module and the claims module and to use the data to calculate a discount amount.

In a system and method for verifying the accurate processing of medical insurance claim data by one or more health insurance companies, a healthcare provider enters claim data into a provider terminal. The provider terminal transmits the claim data to an insurance claim processor that processes claims for payment on behalf of one or more health insurance companies. Upon receipt of the processed claim data from the insurance claim processor, the provider terminal compares the processed claim data with the claim data originally submitted to the insurance claim processor and generates comparison data indicating whether the original claim data has been processed in accordance with predetermined claim processing rules. The health care provider terminal may also generate and retransmit revised claim data when the processed claim data has not been processed in accordance with the predetermined processing rules or within a defined period of time.

A system is disclosed that is useful by hospitals and other healthcare providers for automatically determining the best possible or maximum amount of payments a healthcare provider can lawfully expect to receive for healthcare resources which takes into account various discounts agreed upon by the healthcare provider with various private insurance companies as well as public (i.e., government) insurance providers, which administer managed healthcare plans including Medicare and Medicaid, all payments received against expected payments and a yield measurement approach for determining the providers performance at a given point in time and across various segments of its operations. In accordance with one aspect of the present invention, contracts between a healthcare provider and all private insurance companies and public insurance providers may be modeled. Various data including healthcare resources provided to patients up to a given point in time, applicable insurance company, and healthcare resource code are entered into the system. The system is able to calculate the best possible revenue that the healthcare provider can lawfully expect to receive taking into account the various discounts negotiated with the various insurance companies. Indeed, once the data is loaded, the system can provide an accurate snapshot of a healthcare provider's best possible expected revenues at any given time based upon services rendered instead of waiting until the healthcare resources have been billed out to insurance companies, patients, and third party payers. It can also provide an accurate snapshot of all payments received against those expected payments to determine yield across various segments of its operations.

The present invention provides a refund management method, which is applied to a refund management device, and the refund management device communicates with an external server and an internal server. The method includes the following steps: receiving a medical insurance product refund request sent by a sales platform , the sales platform runs on an external server or an internal server; according to the refund request, the policy information is obtained from the core system of the internal server; when the policy information does not contain bank card information, the sales platform or the core The system obtains the reconciliation area code of the medical insurance product; and obtains the account information of the corresponding third-party payment platform from the financial system of the internal server according to the above reconciliation area code, and controls the financial system to return the refund amount to the third-party payment platform in the account. The invention also provides a refund management device and a computer-readable storage medium.

An inventory management system manages information regarding medical items dispensed to a patient in a medical facility. Inventory sensors sense removal of medical items from an inventory space to be dispensed to the patient. Software instructions associate item information with patient information that identifies the patient, determine billing codes associated with the dispensed items, generate billing information including the patient information and the billing codes, and generate an invoice directed to the patient's medical insurance provider. The instructions also verify that the billing codes are associated with medical items appropriate for treatment of the patient's condition indicated by diagnostic codes included in the billing information, and generate an alert message if the billing codes are associated with medical items that are not reimbursable or are inappropriate for treatment of the diagnosed condition. The alert message is sent to the physician who diagnosed the patient and provided the diagnostic code.

The invention discloses a tax withholding and paying system for confirming payment according to secondary identity identification of a tax payment identification code. The system comprises a third-party payment platform, a bank account, user main bodies registered by using the tax payment identification code, a government tax institution account and a government pension medical insurance account.Secondary identification confirmation charging refers to high-speed charging, bus and subway charging, parking lot charging and the like which need to judge the amount and confirm the identity according to the distance or duration. The identity confirmation needs to bind a license plate according to the tax payment identification code, or a fingerprint or a face of a user, identity recognition hardware is scanned twice through an initial terminal and an end terminal to confirm that payment should be carried out, and the third-party payment platform withdraws tax fee for payment according to the tax recognition code and transfers the tax fee to a related charging company account, a government tax institution account and a government pension medical insurance fund account.

Disclosed is an insurance data processing method, comprising: a terminal acquiring an input insurance policy number, and acquiring corresponding scene information according to the insurance policy number, wherein the scene information comprises multiple responsibility attributes, and responsibility attribute values corresponding to each of the responsibility attributes; the terminal acquiring an input responsibility attribute value, and acquiring, according to the input responsibility attribute value, a responsibility attribute in matched scene information, and comparing the input responsibility attribute value with the responsibility attribute value corresponding to the acquired responsibility attribute; when the input responsibility attribute value is identical to the responsibility attribute value of the acquired responsibility attribute, reading pre-stored compensation rule data corresponding to the scene information; and processing the compensation rule data to obtain a compensation numeric value, generating a compensation instruction, and sending the compensation instruction to a payment platform.

In particular, systems and methods for facilitating the purchase of health-related items such as durable medical equipment are provided. In one embodiment, a method comprises: responsive to a selection of a health-related product input by a user, automatically determining if the health-related product is a qualified healthcare expense; calculating an out-of-pocket cost to the user of the healthcare product based on a health insurance plan of the user; and generating a coupon for the health-related product that discounts a retail cost of the health-related product to the out-of-pocket cost responsive to a merchant accepting the coupon. In this way, a healthcare consumer may utilize their healthcare insurance benefits to purchase health-related products such as durable medical equipment from retail merchants.

The embodiment of the invention provides a medical insurance financial user information encryption method and system based on big data. According to the method, the first number of characters in the first character string are sequentially stored in the queue, and then the second number of characters in the second character string are stored in the queue, so that the user name and the user passwordcan be restored from the user information queue more easily. According to the method, the characters in the first character string are randomly stored in the queue, so that the encryption of the userinformation is improved, the target ciphertext is not easy to crack, and the security of the user information is improved.