Methods and card for accelerated provision of funds and fraud reduction for healthcare

Description of equivalent WO 2004049128 A2

METHODS AND CARD FORACCELERATED PROVISION OF FUNDS AND FRAUD REDUCTION FOR HEALTHCARE

CROSS-REFERENCETORELATEDAPPLICATIONS

[0001] This application claims priority to U .S. P atent Application S erial No. 1 0/303,631, filed November 25, 2002, 10/303,217, filed November 25, 2002, 10/428,609, filed May 2, 2003, and 60/461,225, filed April 8, 2003, all of which are incoφorated by reference herein.

FIELD OF THE INVENTION

[0002] Embodiments of the present invention relate to methods for providing funds, using a card known as a smart card that contains identification and other information to service providers. The invention also relates to using a smart card to reduce fraud on insurance companies. The embodiments further relate to a smart card and a card having a magnetic strip, which can be used with the methods described herein.

BACKGROUND OF THE INVENTION

[0003] Physicians have traditionally had to wait long periods of time to get paid for their medical services. Physicians, physical therapists and others have been required to extend credit to individuals with insurance in order to get paid. This situation has become tedious and caused health care costs to be very high.

[0004] Pharmacists have had the use of automated services, such as the TeleP AID system. The TeleP AID system o ffered by P ADD prescriptions LLC is a system that uses a plastic card that contains only a group number. A pharmacist, in turn, manually enters the group number, member number, and prescription information, in as attempt to give the card holder the lowest customer price into the system. The pharmacist then provides the customer with the prescription and collects the approved amount from the TeleP AID system. The customer is given a receipt including authorization number. This system has the insured paying for the balance. A need has long existed for a system, wherein the insurer pays funds quickly and where the insured does not have to handle money for services rendered.

[0005] Unfortunately, the payment for the delivered health care is now occurring much later than the delivery of the service. Increasingly, health care providers are acting as credit institutions for the insured because of the lack of insurers to timely provide funds under a policy.

[0006] The cost of supporting patient costs has increased during recent years, thereby contributing to today's costly health care system. A significant portion of the increase in the cost of medical service is caused by the administrative costs represented by the systems for creating, reviewing and adjudicating health care provider payment requests. Such payment requests typically include bills for procedures performed and supplies given to patients. Cunently, the systems for reviewing and adjudicating payment requests represent additional health care transaction costs that directly reduce the efficiency of the health care system and increases the cost of the health care delivered.

[0007] A need exists to reduce the magnitude of transaction costs involved in reviewing and adjudicating payment requests by eliminating adjudication procedures.

[0008] A need exists to reduce the traditionally high cost of health care administration, including the review of payment requests which results from health care service providers having to act as "banks" or "credit sources" for patients.

[0009] A need exists to facilitate the understanding of the contractual obligations between the service provider and the insured. Often, there are many different contractual arrangements between different patients, insurers, and health care providers. The amount of authorized payment may vary by the service or by procedure, by the particular contractual arrangement with each health care provider, by the contractual arrangements between the insurer and the patient regarding the allocation of payment for treatment, and by what is considered consistent with current medical practice.

[00010] Other methods and apparatus exist to attempt to streamline the insurance claim payment process, such as the method disclosed in Gamble US Patent 6,163,770. This patent reveals using a digital electrical apparatus to generate output for insurance documentation for a first insurance policy having a first risk and claims while revealing a concurrent second insurance policy for a second risk, wherein the second risk is different from the first. The processor of this method is connected to a memory device for storing and retrieving operations including machine-readable signals in the memory device, to an input device for receiving input data and converting the input data into input electrical data, to a visual display unit for converting output electrical data into output having a visual presentation, to a printer for converting the output electrical data into printed documentation, wherein the processor is programmed to control the apparatus to receive the input data and to produce the output data by steps including: inputting actuarial assumptions defining the first insurance policy; and computing a value of a specific financial attribute of the first insurance policy; the method further including the step of inserting the value of the financial attribute in the first insurance policy and other printed documentation related to the first insurance policy.

[00011] In view of the foregoing, there is a need for more a fully automated claims processing system that have the ability to have an accelerated payment and an ability to reduce the uncertainty as to whether a claim to be submitted is likely to be paid or rejected.

[00012] Further, security is an issue of paramount importance in electronic communication.

The card must be secure from all types of intrusion by unwarranted attempts to access. Only the owner of the card can give permission to read the card and establish the communication links to the owner's private files at the insurer or any other location where information may reside. This activity must be incompliance with all applicable privacy laws and the card and its security must have the ability to change along with laws should a change occur. There are other medical laws that also must be complied with in example HIPAA (sp) and others of the like are federal compliance requirements. The smart card method of the invention will facilitate that compliance.

[00013] Embodiments of the present invention have been developed to provide an accelerated claims processing system that would more easily allow health care providers to know what patient and treatment information must accompany insurance claims, whether or not a patient is eligible for accelerated fee payment, and to obtain funds quickly against rendered services from insurance companies. The present invention also includes various elements to provide security for the user. The present invention addresses a need to reduce fraud in healthcare systems.

SUMMARY OF THE INVENTION

[00014] Embodiments of the invention relate to a method for accelerating the provision of funds to a service provider from medical insurance using a smart card, comprising the steps of: obtaining medical insurance coverage from an insurer for a person; creating a smart card for the person, wherein the smart card comprises: information about medical insurance coverage for the person and a personal identification code.

[00015] Next, the smart card is used to determine if the person is eligible for accelerated provision of funds from the insurer to a service provider for medical services based on medical insurance coverage.

[00016] The smart card is used to determine if a medical service is preauthorized by the insurer for the person. [00017] The smart card is used to determine if a service provider is preauthorized by the insurer to perform a medical service. Once these determinations are made, the smart card facilitates a first transmission from the service provider to the insurer. The first transmission can include information relative to medical service costs, information on the medical services provided to the insured; and an acknowledgement that the medical service has been rendered from the service provider to the person.

[00018] The smart card facilitates the receipt of a second fransmission from the insurer to the service provider. The second transmission preferably comprises the amount of payment required by the person based on the insurance coverage. In addition, the smart card facilitates a third transmission to the insurer from the service provider.

This third transmission comprises an acknowledgement that the amount of payment required by the person is based on the insurance coverage, such as the co-payment or the deductible amount. On approximately the same day that the third transmission is received by the insurer, funds are transmitted from the insurer to the service provider for the medical service provided to the person.

[00019] Embodiments of the invention further include a smart card for accelerating the provision of funds to a service provider for medical insurance.

[00020] Further, embodiments of the invention include additional methods for reducing fraud in a healthcare program. These methods generally include registering a service provider with a private healthcare provider and issuing a service provider identification code, registering at least one service or at least one good of the service provider with the private healthcare provider and identifying a claim code for each registered service or registered good and issuing a smart card to an individual related to the healthcare program, wherein the program is associated with a private healthcare provider, wherein the individual has an individual identification code, and wherein the smart card has a smart card identification feature to identify the individual.

[00021] The method further includes using the smart card identification feature to determine if the individual is the authorized bearer of the card and is eligible for benefits from the healthcare program, using the smart card to determine if a s ervice p rovider i s preauthorized to provide a registered product or registered service under the healthcare program, using the smart card to facilitate a first fransmission from the service provider to the private healthcare provider, wherein the first transmission includes the service provider identification code, the individual identification code, proposed information selected from the group consisting of proposed product information for the individual^ proposed service information for the individual; corresponding claim codes for the proposed product; and corresponding claim codes for the proposed service and a request to confirm the individual's eligibility for benefits under the healthcare program, a validation that the proposed good or service is approved for the individual, the service provider's eligibility to render services or provide goods under the healthcare program and a request to participate in an accelerated payment program for the proposed good or the proposed service and using the smart card to facilitate a second transmission from the private healthcare provider to the service provider, wherein the second transmission includes the individual's eligibility for benefits under the healthcare program, a validation that the proposed good or proposed service i s approved for t he i ndividual, a v alidation o f t he s ervice provider's eligibility to render services under the healthcare program, a confirmation that an accelerated payment program is available and an authorization code to provide the proposed product and/or proposed service.

[00022] The method further includes using the smart card to facilitate a third transmission from the service provider to the private healthcare provider, wherein the third transmission includes a claim codes list for services rendered, acknowledgement by the individual that information on the product and/or service was provided to the individual, acknowledgement that the product or service has been received from the service provider and a request for accelerated payment by the private healthcare provider to the service provider.

BRIEF DESCRIPTION OF THE DRAWINGS

[00023] The present invention will be explained in greater detail with reference to the appended figures, in which:

[00024] FIG 1 is a diagram of an overall method of the invention for accelerated payment;

[00025] FIG 2 is a diagram of the first fransmission;

[00026] FIG 3 is a diagram of the second transmission;

[00027] FIG 4 is a diagram of the third transmission;

[00028] FIG 5 is a diagram of a smart card usable in the invention;

[00029] FIG 6 is a picture of a smart card;

[00030] FIG 7 is a representation of information included in a microchip;

[00031] FIG 8 shows the service provider information stored in the smart card;

[00032] FIG 9 show coinsurance information stored in the microchip;

[00033] FIG 10 shows transmission codes stored in the smart card;

[00034] FIG 11 is a diagrammatic representation of another overall method of the invention for reduction of fraud in healthcare systems; [00035] FIG 12 is a diagrammatic representation of the first transmission;

[00036] FIG 13 is a diagrammatic representation of the second transmission; and

[00037] FIG 14 is a diagrammatic representation of the third transmission.

[00038] The present invention is detailed below with reference to the listed Figures.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[00039] Before explaining the present invention in detail, it is to be understood that the invention is not limited to the particular embodiments and that it can be practiced or carried out in various ways.

[00040] Embodiments of the invention relate to a method for accelerating the provision of funds to a service provider from medical insurance using a smart card. This means, the method relates to the provision of money, such as $75 for an office visit, to a general practice physician from a medical insurance provider, such as a United Health Care Select Plus POS™ using a plastic card. The plastic card, can in some embodiments, includes a chip. It is also contemplated that a plastic smart card could be used with a magnetic strip without a chip provided it has security codes or biometric reading ability affiliated with the magnetic strip.

[00041] Embodiments of the invention contemplate a smart card is issued to an individual and is tied or otherwise related to a particular healthcare program. The healthcare program can be a private healthcare program, such as a private insurer, or a governmental healthcare program, such as Medicare or Medicaid, for example.

Medical insurance coverage can be state government insurance, such as a Texas Employer's Insurance, or even private medical insurance coverage, such as Guardian medical insurance or United Health Care Insurance. [00042] It should be noted that in the context of this invention, the insurer is considered an entity that has been authorized by the federal government or a state board of insurance to deliver insurance benefits for medical care to individuals.

[00043] Additionally, the insurer, as a step in the process, must make contracts with various service providers, such as pharmacists, nurses, doctors, nursing homes that can be linked to the smart card.

[00044] Preferably, the individual has an individual identification code and the smart card has a smart card identification feature to identify the individual, such as through a biometrics reading device, like a fingeφrint reader or a retinal reader. The smart card can contain information about benefits for which an individual is eligible and an identification code, such as a "PIN" or other type of identification. Alternatively, the smart card can contain a biometrics "key" that unlocks a database of retrievable information accessible through a central database.

[00045] The card is contemplated to preferably contain information on at least one or more of the following:

a. insured name (example - Richard Wood);

b. insured address (example - 2396 Wood Street, Houston, Texas 77019);

c. insured phone (example - 713-323-5555);

d. insured fax (example - 713-323-5554);

e. insured email (example - Wood@aol.com);

f. insurer name or plan manager name (example - a privately funded plan such as Klein Independent School District Employee Benefit Plan of Texas); g. insurer address or plan manager's address (example - the address for the Klein plan PO Box 672528, Houston, Texas 77267);

h. insurer phone or plan manager's phone (example - 281 -873-8682);

i. optionally, the insurer fax or plan manager' s fax (example- 281 -872-8282);

j. optionally, insurer e-mail or plan manager's email;

k. insurer's website or plan manager's website (example - www.hasonline.com);

1. insurer claims representative name or plan manager's representative (example - Health Administration Services, Inc.);

m. type of plan (example - PPO);

n. insured policy number or plan number (example - Group 200116289.);

o. insured group number or group plan number (example - KL1NASD);

p. insured's co-pay amount (example -$25);

q. insured deductible amount (example - $500 deductible);

r. insured's medical history (example - allergy to penicillin);

s. instructions (example - pre-certification instructions or urgent admission instructions or emergency admission instructions can be embedded in the card);

t. other phone numbers (example - a phone number for prescription information, a phone number to locate qualified pharmacies under the plan, a phone number to call an approved pharmacist, a phone number to talk to a insurer's nurse, a phone number for mental health questions, and/or a phone number for chemical dependency);

u. issue date or "validity" date;

v. an expiration date or "expiry date";

w. statements as to ownership of the card;

x. statements as to eligibility of the holder as to the rights of the card and the existence of written agreements related to the card; and

y. disclaimers concerning use, misuse and revocation of the card.

[00046] It should be noted that some insurance plans have many choices of service plans, for example, the Klein plan has choices including Heath Administration Services Med- watch Program for hospital confinements, HHPO (a Health Administration Services

Select Hospital Network), an Immediate Care Prescription Program, and a Mail Order Pharmacy Program. All this information can be embedded on a smart card of the invention. Alternatively other codes can be embedded in the card, such as other prescription codes, including the basic insurance number (BIN) number.

[00047] Additionally, the card can include complete or partial information on the insured's medical history, such as, but not limited to, information on health allergies, like allergies to penicillin. Health problems, such as an insured has diabetes or has high blood pressure or even very low blood pressure, can be embedded on the card. The card can include "health alerts" such as those concerning the taking a blood thinner, or any other prescription medications that a doctor or emergency room person should particularly be aware of. Additionally, information concerning whether or not the insured has allergies to two or more prescription drugs can be contained in the card. Smart cards for use in the methods described herein are described in further detail below.

[00048] Using the smart card, particularly when the smart card contains biometric codes, the level of information passing to the healthcare provider cab be increased because security is increased, resulting in accelerated review and payment of any claims.

[00049] The smart card can contain information on funds which are available from an insurer for a completed authorized medical service for a particular patient. For example, the card can contain information on the "accelerated fund payment schedule" or the typical payment schedule for a particular medical service if the two differ. Generally, the phrase "completed authorized medical service" is considered to be a service which has been authorized by contract by the insurer or is a stated item of coverage in an insurance policy, such as "all dental cleanings are priced at $35".

[00050] The accelerated fund payment schedule could be a 100% payment schedule or a partial accelerated fund payment schedule depending on the contract with the insurer. It is contemplated that the funds would move electronically from the insurer's bank account to the service provider's bank account, such as by wire transfer, or similar normal electronic banking procedures.

[00051] The methods described herein advantageously reduce fraud on insurance companies and governmental healthcare programs by eliminating physician or service provider's inadvertent creation of non-patients and people who do not exist. They further eliminate codes for billed services that were not actually rendered. Additionally, embodiments of the invention permit a comparison of lists of doctors against patients names and the insurer's records for an easy audit. Also dates of service approved could be compared to services performed dates to audit record and reduce fraud.

[00052] The methods described herein also advantageously prevent/minimize ineligible users from using services for which they are not authorized. The invention safe guards the government from users attempting to apply for the same service more than once, in other words "double dipping".

[00053] The steps of one embodiment include first obtaining medical insurance coverage from an insurer for a person.

[00054] Typically, a person completes an application for insurance through their employer or individually and submits the information and premium to the insurance company. A policy is then issued to the person for the insurance coverage. The policy can be an individual policy or a group policy.

[00055] Next, a smart card is created for the insured. For the chip version of the smart card, the card is first manufactured in a conventional manner, and then the relevant information is downloaded from the computers of the insurance company to the card's chip. For a non-chip version of a smart card, the card manufacturer would be provided information about the insured from the insurance company and embed the relevant information in the magnetic strip and then mail or transfer the magnetic strip card to the user.

[00056] The insured can be the primary insured, a spouse, a non-married "significant partner", at least one dependent, such as one or more children, or it can be combinations of these.

[00057] It is also contemplated to be within the scope of the invention that the primary insured can be an animal, such as a thoroughbred horse, like Secretariat the winning race horse, a famous breeding bull or some other type of registered pure-bred animal, such as an American Kennel Club (AKC) registered animal. The primary insured, if an animal, can be linked with an appropriate animal insurance policy, such as those available through the AKC. [00058] The smart card can contain information about medical insurance coverage for the insured (person or animal) and a personal identification code, such as a personal identification number or "PIN".

[00059] The smart card is an electronically readable card and can connect to the service provider of the insurance contract, and may be usable via the Internet or telephone line.

[00060] Alternatively, e lectronic c laims submission information through WebMD or THIN that would have a payer identification number embedded in the card can be used.

[00061] The smart card can contain information about the various insurance coverages held by the insured. An insured person can have insurance that could cover dental coverage, medical coverage, mental health, prescription drugs, nursing care, emergency room procedures and the like.

[00062] In the method, the smart card is used to determine if the person is eligible for accelerated provision of funds from the insurer to a service provider for medical services based on medical insurance coverage.

[00063] Additionally, the smart card can be used to determine if a medical service is preauthorized by the insurer for the person, such as for a "John Doe", who is preauthorized for all chest x-rays without need for additional authorization from the insurer.

[00064] The smart card can be used to determine if a service provider is preauthorized by the insurer to perform a medical service. For example, the smart card can contain information the all blood work related to sugar testing is pre-approved by the insurer.

[00065] The smart card is used to not only contain the information described above, but to link to the insurer's database and between the insurer's database and the service provider's database and the service provider's bank account. The smart card facilitates a first transmission from the service provider to the insurer. This first transmission can include information on:

i. determination that the card is valid and the person is eligible;

ii. determination that the service provider is authorized to provide the service;

iii. proposed medical service costs;

iv. information on the medical services; and

v. an acknowledgement that at least one medical service has been rendered from the service provider to the person.

[00066] The smart card facilitates the receipt of a second fransmission from the insurer to the service provider. This second transmission can contain information on the amount of payment required by the person based on the insurance coverage. The amount of payment can be all or part of a co-payment fee, all or part of a deductible fee and combinations of these fees.

[00067] The smart card facilitates a third transmission to the insurer from the service provider. This third transmission would include an acknowledgement that the amount of the co-payment and the deductible have been paid by the person to the service provider thereby initiating payment by the insurer.

[00068] The method includes approximately same day payment relative to the day that the third transmission is received by the insurer, or perhaps only a few days later. Funds are then transmitted from the insurer to the service provider for the medical service or goods provided to the person. This accelerated payment plan is a vast improvement over known systems that take up to eight months to pay a service provider.

[00069] This method contemplates that the medical service can be a service or product related to a health procedure. This procedure can be an operation or an out-patient procedure. The medical service can apply to prescription filing; medical examinations, medical tests, medical diagnosis, eye glass prescriptions, dental examinations, dental procedures, mental health procedures, mental health therapies, physical therapy, podiatrists, doctor's visits, hospital visits, out-patient visits, and combinations of these and other procedures that have not been named.

[00070] This method contemplates that the smart card can be used to determine if a second opinion is required by the insurer for a medical service.

[00071] Now and with reference to the figures, FIG 1 shows a diagram of the overall invention.

[00072] In FIG 1, a person obtains medical insurance from the insurer (100) and obtains a service provider contract (101). A smart card is created (110). The smart card is used to see if the person if eligible for funds (120). If the user is eligible, the process proceeds. If they are not approved, the process ends. The smart card is next used to see if the medical service is preauthorized (130). Again, if the medical service is not preauthorized, the method ends. The smart card is next used to see if service provider is preauthorized (140). If all of the eligibility and preauthorization is met, the process proceeds. The smart card is used to facilitate a first transmission from the service provider to the insurer. A second transmission is made from insurer to service provider, which can include information on the preauthorized services (160). A third transmission is made from service provider to insurer acknowledging various items including payments (170) from the insured. Finally, payment is transferred from the insurer to the service provider (180).

[00073] The smart card also contains information on whether the person is eligible for accelerated funding from the insurer for medical services based on the insurance coverage. The card can link via the chip to the insurer's database to obtain information on whether a service provider is preauthorized by the insurer to perform a medical service.

[00074] As shown in FIG 2, the smart card facilitates the transmission of medical cost information via a first transmission to the insurer (140). The first transmission includes service provider identification (152), insured identification (154), proposed medical s ervice information ( 156), and a request to confirm (157). The request to confirm (157) involves a request for eligibility for medical insurance coverage (158) and a request for medical service accelerated payment availability (159).

[00075] Further shown in FIG 2, the first transmission (140) can also include a first transmission identification code (510), service provider information (520), insured information (530), and description of symptoms of insured (540). The service provider information (520) includes service provider code (710), service provider name (720), service provider address (730), service provider office code (740), and service provider phone number (750). The insured information includes insured name (205), insured address (210), insurer phone (215), and insured social security number (212). The first fransmission can include all or a combination of these elements.

[00076] As shown in FIG 3, the smart card can be used to facilitate a link to the insurer's database to obtain information in a second transmission (160) that concerns the amount of payment required by the person to the service provider based on the insurance coverage. The second transmission (160) includes confirmation of medical insurance coverage (161), confirmation of medical service accelerated payment availability (162), an a lert t o t he s ervice p rovider t hat a p ortion o f t he funds m ay need to come from the insured and an indication of that fund amount (163), type of policy held by the insured (164), claim code for the insured (165), contact person at the insurer (166), and authorization code to perform the medical services (167) and authorization to guarantee payment for the rendered services (160).

[0 ) m00077] Further s hown i n F IG 3 , t he s econd t ransmission ( 160) c an a lso i nclude a s econd transmission identification code (610), information on co-payment amount (620), information on deductible amount (630), reference codes from the insurer to be used by the service provider to perform the services (640), co-insurer information (650), a notice as to further services potentially needed by the insured (660), and a photo of the insured (670). The co-insurer information can further include the name of the co- insurer (652), co-insurer's policy number (654), and amount of funds to be paid by the co-insurer (656). The second fransmission can include all or a combination of these elements.

[00078] As shown in FIG 4, the smart card can then be used to facilitate a third transmission (170) from the service provider to the insurer that contains an acknowledgement of the medical service costs (172), information on the medical service provided to the insured (174), acknowledgement that the medical service has been rendered from the service provider to the insured (176), and acknowledgement that funds were collected from the insured by the service provider (178).

[00079] Further shown in FIG 4, the third fransmission (170) can also include a third transmission identification code (710), claim number (720), date medical service was rendered (730), total amount charged to insured (740), statement as to amount that exceeded approved medical service costs (750), detail on reference codes for rendered medical services (760), discount applied by the medical services provider for a rendered medical service (770), information on funds collected which includes co-payment amount collected and deductible amount collected (780), and an amount to be billed to a co-insurer (790). The third fransmission can include one or a combination of these elements.

[00080] Finally, and on approximately the same day that the third transmission is received by the insurer, funds are transmitted to the service provider's bank account from the insurer for the medical service provided to the person.

[00081] Other information that can be communicated to the insured includes transmitting the annual and ever-to-date insurers, co-payers, and deductible payment history and additional insurers report. The complete medical history, including diagnosis, treatments, and prognosis, can be communicated to the insured in a concise report.

[00082] The information shared in this process is readily available to the insured. The insured can ask the service provider for any of these corresponding reports during a visit. The hard ware (card reader) and/or software (reporting and accessing program) in the possession of the service provider give access to these reports at a time of their choosing.

[00083] FIG 5 shows a front view of the smart card (200), while FIG 6 shows the back view of the smart card (200). Physically, the smart card (200) includes a card substrate and a microchip (220) embedded in the card substrate. As seen in FIG 5, the smart card also has a picture (2100) of the user along with design markings (207) identifying the card as a smart card (200), the name of the user and other common identifiers. These design markings (207) can be the mark of insurer, the mark of the service provider, and the mark of any third party. Examples of third parties includes an insurance middle middleman, a pharmacy, a medical equipment provider, a financial institution, a grocery store, a manager of a medical plan, a car rental agency, an airline, a office supply chain, a hotel chain, recreational company marks and combinations thereof.

[00084] As seen in FIG 6, the back of the smart card (200) has a magnetic medium (240) and a place for the user to sign his name (245) so any signature can be verified.

[00085] The smart card (200) includes numerous security devices to protect the user. FIG 5 shows that the microchip (220) can include eye information (225), fingeφrint information (230), and digital signature information (235). Electronic fingeφrinting and fingeφrint r ecognition i s a c urrently believed secure method of identification. This is far more secure than PIN codes that can be obtained even when encrypted relatively easily. Social security numbers are generally not considered secure. It is necessary for the individual who owns the smart card to have unique identifiers to allow access to the information on the card. Using first a fingeφrint encoding device, the fingeφrint or fingeφrints of the owner of the card are loaded onto the non re- writable portion of the card's chip. A fingeφrint reader connected to the card reader matches the real time image of the fingeφrint(s) to the stored image and then provides electronic verification that the card and its owner are together at the same time. The owner can then enter a PIN code or other security code that will allow access to the information on the card by the then approved reader. The owner's authorization allows information to be shared between approved parties.

[00086] In the same way the fingeφrint devices and stored images can be used for matching, other verification and authorization recognition devices can be used as well. Laser or optical retinal scanning and facial recognition scanning use the same techniques with different equipment. First, the image of the retina of the owner's eye is scanned and recorded permanently onto the chip of the card in a non-changeable location and format. At the time of verification a scanner is used to scan the card owner's retina in real time and compare the recorded image to the real time one. If there is a match then the owner's identity is verified and they can proceed to provide other authorizations as above.

[00087] Facial recognition works in the same manner as retinal scanning as does several other forms of "optical" recognition and verification. The smart card (200) is contemplated to have all of these security measures.

[00088] The microchip (220) also has information about the insurer and insured. FIG 7 is representation of the information included on the microchip (220). The microchip (220) includes information pertaining directly to the insured. This insured information is the name (302), address (304), phone number (306), social security number (308), fax number (310), and e-mail address (312). T he microchip (220) also has information about the insurer like the insurer name (314), insurer address (316), insurer phone number (318), insurer fax number (320), insurer e-mail address (322), the insurer claims representative (324), and insurer website (354).

[00089] The microchip (220) also includes information that assists in accelerating the provision of funds to a service provider for medical insurance, as shown in FIG 7.

The microchip (220) has the insured policy number (326); the insured group number (328); insured's co-pay amount (330); insured deductible amount (332); insured's medical history (334); and the insured type of plan (336). The microchip also contains secondary information such as the insured pharmacy plan (338); pharmacist phone number (340); insured prescription history (342); and emergency care health conditions (346). The microchip (220) also includes other phone numbers (344), instructions on how to contact insurer (348), expiration date of card (350), and expiration date of policy (352), and any other combinations of the included information. [00090] The microchip (220) can also have medical information, like medicinal prescriptions, for executing the medical transaction.

[00091] The smart card (200) functions to communicate various types of information between insurer, insured, and other parties concerned in accelerating the provision of funds to a service provider for medical insurance. The functions of the smart card (200) include:

i. communicating one or more of the information items encoded on the microchip (220) and shown in FIG 7;

ii. verifying the insured is the owner of the smart card;

iii. communicating the insured's identification information to the insurer;

iv. communicating the insured's symptoms to the insurer;

v. communicating the service provider information to the insurer;

vi. communicating transmission codes;

vii. communicating insurance coverage is current to the service provider;

viii. communicating claim codes for an insured;

ix. communicating deductible and co-payments required of insured;

x. communicating co-insurance information;

xi. communicating insured's medical history to enable a service provider to evaluate a proposed treatment;

xii. communicating the proposed treatment to an insurer; xiii. communicating the cost to be charged from the proposed treatment;

xiv. communicating from the insurer that the cost of proposed treatment fit within the guidelines of the insurer;

xv. communicating authorization codes to perform the proposed treatment;

xvi. communicating notice from the service provider that additional service for the insured may be needed;

xvii. communicating eligibility of a service provider for accelerated funds transfer;

xviii. communicating that the proposed treatment to the insured has been provided to the insurer;

xix. communicating the deductible and co-payments were made by the insured to the service provider to the insurer;

xx. communicating annual and ever-to-date insurers report to the insured;

xxi. communicating complete medical history to the insured;

xxii. communicating the status of payment to the service provider for the proposed treatment; and

xxiii. communicating combinations thereof.

As listed above, one of the functions of the smart card (200) is to communicate the service provider information to the insurer. FIG 8 shows the service provider information stored in the smart card (200). The information found on the microchip

(220) includes service provider name (410); service provider code (420); service provider address (430); service provider phone number (440); service provider office code (450); service provider's diagnosis (460); service provider's treatment (470); and service provider's prognosis (480).

[00093] Another function of the smart card (200), as listed above, includes communicating co-insurance information. FIG 9 is a diagrammatic representation of the coinsurance information stored in the microchip (220) on the smart card (200). The insurance information is the name of co-insurer (5100), the policy number of co- insurer (5200), the amount of funds to be paid by co-insurer (5300), and combinations thereof.

[00094] FIG 10 shows the transmission codes stored in the smart card (200). The transmission codes are also located on the microchip (220). The transmission codes are for medical history diagnosis (6100), treatment (6200), prognosis (6300), and combinations of a medical history (6400). Other transmission codes are for insurance payment h istories. T hese c odes are for histories from i nsurer p ayments (6500), from insurer co-pay payments (6600), from insured deductible amounts

(6700), from additional insurers (6800), and for combined insurance payment histories (6900).

[00095] The smart card (200) itself can further have a magnetic medium (240) on the card substrate. Both the microchip (220) and the magnetic medium (240) can contain all or a portion of the information. In one embodiment, the card (200) includes the microchip (1200) or the magnetic medium (240).

[00096] In an alternative embodiment, the smart card (200) is a magnetic readable card for accelerating the provision of funds to a service provider for medical insurance with a card substrate and a magnetic medium on the card substrate.

[00097] FIG 11 shows a diagram of another embodiment of the methods described herein. First, a service provider is registered with a private healthcare provider (1100) and the service provider is given an identification code is (1110). Next, at least one service or good of the service provider is registered with the private healthcare provider (1120) and a claim code is given for the given registered service or good (1130).

[00098] The smart card is, then, used to determine if the individual is the authorized bearer of the card (1140) and if the individual is eligible for the benefit of the healthcare program (1150).

[00099] The smart card is used using the smart card to facilitate a first transmission from the service provider to a program administrator (1170) for a private healthcare provider.

[000100] As shown in FIG 12, the first transmission (1170) includes service provider identification (2110), individual identification code (2120), proposed information (2130), and a request to confirm (2140). The proposed information (2130) involves proposed product information for the individual (2132), proposed service information for the individual (2134), corresponding claim codes for the proposed product (2136), and corresponding claim codes for the proposed service (2138). The request to confirm (2140) entails validation that individual's eligibility for benefits (2142), the proposed good/service is approved for the individual (2144), service provider's eligibility to provide good/service (2146), and request to participate in an accelerated payment program (2148).

[000101] The first transmission (1170) can further include a first fransmission identification code (2160); service provider information (2170); and individual information (2180).

Examples of service provider information (2170) are service provider code (2172), service provider name (2174), service provider address (2176), service provider office code (2178), and service provider phone number (2179). Examples of individual information (280) are individual name (2182), individual address (2184), private healthcare provider phone (2186), and individual social security number (2188), and combinations of these.

[000102] Referring back to FIG 11, the smart card is used to facilitate a second fransmission from the private healthcare provider to the service provider (1180).

[000103] As shown in FIG 13, the second transmission (1180) includes individual's eligibility for benefits under the healthcare program (3110), validation that the proposed good or proposed service is approved for the individual (3120), validation of the service provider's eligibility to render services under the healthcare program (3130), confirmation that an accelerated payment program is available (3140), and authorization code to provide the proposed product and/or proposed service (3150).

[000104] The second transmission (1180) can also include notice as to further goods/services potentially needed by the individual (3160), depiction of the individual (3170), a second transmission identification code (3180), and combinations thereof.

[000105] Referring back to FIG 11, the smart card, next, is used to facilitate a third transmission from the service provider to the private healthcare provider (1190).

[000106] The third transmission (1190), shown in FIG 14, involves list of claim codes for services rendered (4110), acknowledgement by the individual that information on the product and/or service was provided to the individual (4120), acknowledgement that the product or service has been received from the service provider (4130), and request for accelerated payment by the private healthcare provider to the service provider (4140).

[000107] On approximately the same day that the third transmission is received by the private healthcare provider, funds are transmitted from the private healthcare provider to the service provider (1180) for the product and/or service provided to the individual.

[000108] The third transmission (1190) can also involve a tracking number (4145); date benefit was rendered (4150); total amount charged to individual (4155); statement as to amount that exceeds rendered benefit (4160); detail on reference codes for rendered benefit (4165); a third transmission identification code (4170); and combinations thereof.

[000109] In alternative embodiments, the method can include the step of creating a contractual relationship between the private healthcare provider and a third party for the benefit of the individual. The method can also include the step of disposing marks on the card. Examples of marks on the card are the private healthcare provider, third parties, service providers and combinations thereof.

[000110] The funds can be for a completed authorized benefit. A completed authorized benefit is a service that has been authorized by contract by the private healthcare provider or is a stated item of coverage in a private healthcare provider benefit plan.

[000111] The method described herein is its preferred embodiment is a direct transaction between the service provider and the private healthcare provider using the smart card to facilitate the transaction. In an alternative embodiment, the smart card is contemplated to provide aid to third parties intermediaries.

[000112] These third party intermediaries act as a go between the private healthcare provider programs and the individuals receiving the benefit from a private healthcare provider program. Examples of third party intermediaries are School Meal programs, job placement assistance programs, organizations like Meals on Wheels, and other similar programs.

[000113] The smart card would facilitate access to the funds the private healthcare provider gives to the third party intermediaries. The funds in the third party intermediaries' account would be transferred directly to the service provider once private healthcare provider approved services had been rendered.

[000114] The smart card would also enable the third party intermediaries to report in a more expedited manner without additional labor. The private healthcare provider presently requires regular reports, both on an individual basis and in aggregate, in order for the third party intermediaries to receive funds. Using the smart card eliminates the need for the third party intermediaries to create the reports because the smart card tracks and reports automatically.

[000115] While this invention has been described with emphasis on the preferred embodiments, it should be understood that within the scope of the appended claims the invention might be practiced other than as specifically described herein.