This is for my Medical Banking Group discussion. Back in 2009, I created a business model combining a credit card (in this case AMEX) with a medical claims processing system that would pay the provider immediately the patient portion plus a discounted amount that would come from the insurer. When the insurer paid the credit card company the ccc would keep the difference while the patient also paid the ccc their copayment. Within the system would be a cost containment system pushing the risk of coverage back to the provider assuring clinical need!

1. The Healthcare Transaction
Patient Patient Visits Provider Verifies Collects Co-pay,
Needs Provider Patient Eligibility but no deductible
Care EDI 270 determination
EDI 837 Claim to
Provider Clearinghouse Payer
generates generates EOB
claim Paper Claim to
TPA/ASO/Payer
Provider
sends EDI 835 EOB or
Patient Bill Paper to Provider
to collect Bank cuts
EDI 835 EOB
the balance Check or EFT
to Bank
Employer Funds the Benefit Plan 12

2. The American “Health” Express Card
EMPLOYERS CONSUMERS PROVIDERS
Wealth Management Health Management
Secure your Wealth | Protect your Health
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3. Win + Win + Win + Win Proposition
EMPLOYERS CONSUMERS PROVIDERS
 Value-added service  Transactional ease  Speed of claims payment
for employees with one card solution
 Reduction of credit
 Lower health costs  Health and wellness balances
 Improved wellness  Personal health record  Real-time patient
eligibility data
 Real-time access
to health data
BANK
 Capture all healthcare financial transactions
 Going beyond co-pay and deductible payments
to holding in reserve all health-related funds
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4. CLINICAL CORRELATION
NEGOTIATION/SUPNET
SERVICES REVIEW
CODING REVIEW
Kicking off the transactions
HY
CHARGE
ADJUDICATED
ELIGIBLE
PT PRO ID CARD BENEFITS SERVICES CLAIM PAYER
CO-PAY
PRECERT
BANK
DEBIT
FSA | HRA | HSA
FUNDED PLAN | PREMIUMS ACCOUNT
TREASURY | RETIREMENT | SWEEP
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