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Patent for Medical Payment System Technologies

Patent for Medical Payment System Technologies

Technology Determines What the Patient Owes the Provider at the Time of Service and Intelligently Routes Real-Time Information for Limited Benefit Program, Health Reimbursement (HSA) and Health Reimbursement Accounts (HRAs)

Mission Viejo, CA — The U.S. Patent and Trademark Office has granted Competitive Health (CH) an important patent for its breakthrough technology used in the repricing of healthcare transactions at the time of service. The company’s patent, U.S. Patent 10/338,965, titled “Medical Payment System,” refers to the system and method CH developed for real time repricing and auto-adjudication of healthcare transactions prior to authorizing payment. This patented process ensures that the true “net” payment is made only after eligibility, PPO pricing, scheduled benefits and/or deductible history are determined real-time and eliminates the need for the patient to pay gross billed charges, reduce receivables for providers and reduces the need to file a paper claim. The system is widely used by CH’s clients and permits 100 percent electronic repricing of transactions like physician office visits, lab, dental, and other ancillary providers.

“Competitive Health has made substantial investments in developing auto-repricing and auto-adjudication technologies for the prepaid card and insurance industries and we are pleased that the U.S. Patent Office has recognized the novelty of our approach. This patent validates our position as the technology leader in electronic repricing and auto-adjudication services,” said Kimberly Darling, founder and CEO of Competitive Health. “consumer-directed benefit programs, limited benefit programs, hospital indemnity programs, and healthcare providers all benefit from our advanced technology. CH’s patented real-time, auto-adjudication technology validates the insureds’s transaction prior to payment, providing maximum cardholder convenience, savings and lower administrative costs for carriers,” she said.


About Competitive Health

Competitive Health, Inc., headquartered in Mission Viejo, California, began operation in 1996 with a mission to provide innovative and intelligent payment solutions for the limited benefit and consumer-directed benefits marketplace. Its primary product, First Access™ repricing solution, applies eligibility, PPO fee schedule repricing, deductible history, indemnity office visit benefits, patient and/or carrier payment, multiple fee schedule hierarchy technology including percentage of medicare fee schedule repricing, real-time secondary PPO network identification and patented auto-adjudication technologies to the limited benefit, indemnity, and non-logo secondary PPO and HSA marketplace.. CH’s have other patents that are pending. Competitive Health intelligently routes data and provides real-time solutions to more than 35 managed care and administrative services organizations.