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System and method for secure highway for real-time preadjudication and payment of medical claims
System and method for secure highway for real-time preadjudication and payment of medical claims
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机译:安全高速公路实时预判和医疗索赔支付的系统和方法
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摘要
A system and method for real-time pre-adjudication, funding and payment of medical expenses to a Provider for a Claim, the Claim having a Payer, wherein a line of credit is established that is associated with the Claim. One variation of the system provides automated and optionally network-based assistance to Participants in the health industry. The Participants include: Providers, Payers, Funding Institution, Patients, Employers, and E-Market Exchanges. The method of the system includes: receiving a medical expenses Claim which is scrubbed; prior to adjudication of the Claim funding the Provider from a line of credit, with funding determined using risk analysis tools and utilizing a recorded security interest; collecting payment from the Payer via a secured environment; and repaying the line of credit from the collected Payer payment with follow-up reporting and record keeping.
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