US 8,799,015 B2Granted

Wellcare management methods and systems

AssigneeNestec S.A.

InventorsDavid B. Goodnight, Steven R. Johnson, Thomas J. Blair

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Abstract

Methods and systems related to wellcare management are disclosed. The methods comprise enrolling wellcare providers and consumers, offering wellcare plans, and providing automated payment processing and collection in connection with the wellcare plans. The methods also allow the wellcare management systems to interface with the wellcare provider's practice management software administered by a third party. Preferably, the wellcare plan providers are veterinarians, particularly independent veterinarians. Systems employing the methods over one or more computer networks are also disclosed, as are articles comprising computer readable media.

Claims21

Dependent claims

A method of wellcare management comprising:

(a) enrolling a plurality of wellcare providers;
(b) enrolling one or more consumers for each enrolled provider;
(c) for each provider, offering a plurality of different customized wellcare plans to consumers;
(d) allowing the consumers to select from the wellcare plan offerings;
(e) permitting consumers to enroll one or more patients, wherein one consumer is permitted to enroll a plurality of patients, each patient into a different plan;
(f) for each consumer, obtaining contact and financial information sufficient to permit automated collection by a merchant processor of a periodic payment associated with the selected wellcare plan;
(g) for each provider, obtaining financial information sufficient to permit payment of service fees to the provider from the wellcare manager;
(h) collecting and/or processing periodic payments from consumers using automated payment management including approval and/or decline notification and management thereof;
(i) for each consumer enrolled, managing renewals and/or nonrenewals;
and (j) providing access over a network via a secure portal to providers and consumers to information about the wellcare plans and payments;
wherein steps (a) through (j) occur on one or more computer networks and at least step (j) further comprises, for either or both consumers or providers, data processing elements controlling one or more of:
(1) registering the consumer or provider as a user of the computer network via the secure portal (2) entering a user name and password;
(3) authenticating the user name or password to generate an authenticated user;
(4) restricting the authenticated user to only information pertinent to that user;
(5) directing information input by the user to an appropriate module for further processing;
and (6) follow up communication between two or more modules or between the consumer, the provider and/or the wellcare manager regarding information input by a user.

13 more elements

A wellcare management system operated by a wellcare manager or merchant processor comprising:

(a) a provider enrollment module for enrolling a plurality of wellcare providers;
(b) a consumer enrollment module for enrolling one or more consumers for each enrolled provider and one or more patients for each consumer into one or more wellcare plans offered by the enrolled provider, wherein one consumer is permitted to enroll a plurality of patients, each patient into a different plan;
(c) a payment collection module comprising billing and collection services including one or more of (i) periodic invoicing or billing of consumers;
(ii) automated payment collection and processing;
(iii) automated payment management including approval and/or decline notification and management;
and (iv) renewal management;
(d) a service fee transfer module for paying service fees to each enrolled provider less any fees due the wellcare manager or merchant processor;
(e) a database comprising:
(i) for each enrolled provider, data related to one or more of (1) contact information for the provider;
(2) an identifier unique for the provider;
(3) financial information sufficient to permit payment of service fees to the provider from the wellcare manager;
(4) the content of one or more provider wellcare plan offerings;
(5) operative and/or effective dates for each of the one or more provider wellcare plans;
(6) any changes to the one or more provider wellcare plan offerings and effective dates of the changes;
(7) records of notice of the changes to the consumers;
(8) records of receipt and/or acceptance of such notice by the consumers;
(9) information related to each enrolled consumer and each patient enrolled thereunder for each wellcare plan offered by that provider;
and (10) enrollment and/or payment status for each enrolled consumer including the status of any payment problems or denials;
and (ii) for each enrolled consumer, data related to one or more of:
(1) contact information for the consumer;
(2) information to associate the consumer with an enrolled provider;
(3) information identifying the wellcare plan offering(s) for which the consumer has enrolled;
(4) information for each patient enrolled in each wellcare plan;
(5) an account history for the consumer;
(6) financial information sufficient to permit electronic collection of payments due by the merchant processor;
(7) payment preference(s) for the consumer;
(8) renewal or non-renewal information for the consumer;
and (9) information related to access by the consumer to a secure portal providing information about the plan;
(f) a secure portal access module providing access:
(i) for enrolled providers, wherein said portal allows access to data in the database related to the provider;
the wellcare plan offerings;
approval status for completed consumer applications;
the enrolled consumers and/or patients for that provider;
status of payment of service fees to the provider from the wellcare manager;
payment and/or enrollment status for each consumer or patient associated with that provider;
decline notifications for any consumer associated with that provider;
and/or renewal status for each consumer;
and (ii) for enrolled consumers, wherein said portal allows access sufficient for managing that consumer's data in the database as to consumer contact information, services selected, enrolled patients, financial information, preferred methods of payments, and/or accessing account history, payment history, service history, rectifying payment issues or declines, and renewal decisions;
(g) one or more servers providing access to the database and the portal;
and (h) one or more devices capable of securely accessing a network and viewing and/or entering data in connection therewith;
wherein the provider enrollment module, the consumer enrollment module, the payment collection module and the service fee transfer module comprise software instructions on one or more networks, at least a portion of which are non-public, wherein the software instructions direct one or more computer processors to carry out operations sufficient to implement the function(s) recited for that module;
wherein the database and secure portal are maintained with at least industry-standard security for financial and/or health care data;
and wherein the devices comprise one or more of a personal computer, terminal, netbook, tablet computer, personal digital assistant (PDA), smart phone, or hand-held device, wherein the system comprises, for either or both consumers or providers, data processing elements controlling one or more of:
(1) registering the consumer or provider as a user of the computer network via the secure portal (2) entering a user name and password;
(3) authenticating the user name or password to generate an authenticated user;
(4) restricting the authenticated user to only information pertinent to that user;
(5) directing information input by the user to an appropriate module for further processing;
and (6) follow up communication between two or more modules or between the consumer, the provider and/or the wellcare manager regarding information input by a user.

45 more elements

An article of manufacture comprising a computer-readable storage medium having software stored thereon that, in response to execution by a processor, causes the processor to perform functions comprising:

(a) enrolling a plurality of wellcare providers;
(b) enrolling one or more consumers for each enrolled provider;
(c) for each provider, offering a plurality of wellcare plans to consumers;
(d) allowing the consumers to select from the one or more wellcare plan offerings;
(e) permitting consumers to enroll one or more patients, wherein one consumer is permitted to enroll a plurality of patients, each patient into a different plan;
(f) for each consumer, obtaining contact and financial information sufficient to permit automated collection by a merchant processor of periodic payments connected to the wellcare plan selected;
(g) for each provider, obtaining financial information sufficient to permit payment of service fees to the provider from the wellcare manager;
(h) collecting and/or processing periodic payments from consumers using automated payment management including approval and/or decline notification and management thereof;
(i) for each consumer enrolled, managing renewals and/or nonrenewals;
and (j) providing access over a network to a secure portal providing information to the providers and consumers and at least step (j) further comprises, for either or both consumers or providers, data processing elements controlling one or more of:
(1) registering the consumer or provider as a user of the computer network via the secure portal (2) entering a user name and password;
(3) authenticating the user name or password to generate an authenticated user;
(4) restricting the authenticated user to only information pertinent to that user;
(5) directing information input by the user to an appropriate module for further processing;
and (6) follow up communication between two or more modules or between the consumer, the provider and/or the wellcare manager regarding information input by a user.

12 more elements

Dependencies are inferred from the claim text.

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Abstract

A method of wellcare management comprising:

(a) enrolling a plurality of wellcare providers;
(b) enrolling one or more consumers for each enrolled provider;
(c) for each provider, offering a plurality of different customized wellcare plans to consumers;
(d) allowing the consumers to select from the wellcare plan offerings;
(e) permitting consumers to enroll one or more patients, wherein one consumer is permitted to enroll a plurality of patients, each patient into a different plan;
(f) for each consumer, obtaining contact and financial information sufficient to permit automated collection by a merchant processor of a periodic payment associated with the selected wellcare plan;
(g) for each provider, obtaining financial information sufficient to permit payment of service fees to the provider from the wellcare manager;
(h) collecting and/or processing periodic payments from consumers using automated payment management including approval and/or decline notification and management thereof;
(i) for each consumer enrolled, managing renewals and/or nonrenewals;
and (j) providing access over a network via a secure portal to providers and consumers to information about the wellcare plans and payments;
wherein steps (a) through (j) occur on one or more computer networks and at least step (j) further comprises, for either or both consumers or providers, data processing elements controlling one or more of:
(1) registering the consumer or provider as a user of the computer network via the secure portal (2) entering a user name and password;
(3) authenticating the user name or password to generate an authenticated user;
(4) restricting the authenticated user to only information pertinent to that user;
(5) directing information input by the user to an appropriate module for further processing;
and (6) follow up communication between two or more modules or between the consumer, the provider and/or the wellcare manager regarding information input by a user.

13 more elements