SBIR Phase I: ClaimAway Consumer Financial Health Care Portal

This Small Business Innovation Research Phase I project will investigate the potential of creating a free consumer medical financial management portal. The portal will pull in health care financial data and organize it in a fashion that allows consumers to understand and act on their health care data. The research will also explore the possibility of funding the product by providing value-added solutions to the healthcare industry through innovative software engineering algorithms. The rising costs of health care, the growing popularity of Consumer-driven Health Care plans, and the aging of America?s population have all increased the need for more consumer control over health care finances. Consumers currently have no easy way to reconcile paper statements from payers and providers and are forced to manage it with spreadsheets, notebooks, and sticky notes. Although data for managing medical finances is starting to become available, consumers do not yet have the tools to do it. The 250 million Americans with health insurance are known to be frustrated by the overwhelming volume and complexity of health care financial paperwork. They don't understand if they are being charged correctly, if doctors are filing claims correctly, or if their insurance company is correctly passing costs to them. This confusion causes extra cost to the health care system. Consumers pay bills they do not owe and delay paying bills they do owe. Health Insurance and provider call centers are inundated with customer calls about arcane billing and coding messages on Explanation of Benefits letters. Criminals exploit consumer confusion to defraud payers for hundreds of billions of dollars annually. These frictions all increase health care costs and ultimately result in lower care. The proposed solution will allow use of data mining, analytic rules engines, pattern matching, and other tools to provide consumers with a free health care financial management engine and a fraud detection system for health care payers. If successful, the proposed solution will help consumers become healthier, save money, and help reduce the drag fraud creates on our national competitiveness.