Abstract: System and method for pairing an electronic exchange system with a health care expert system program to mitigate the risk of overpaying for health care and to ensure integrity to financial transactions. During the negotiations of health care, the invention instantly monitors and/or audits financial transaction for compliance, wherein mitigating the risk of overpaying for health care. The system collects knowledge in the form of rules (if-then-form) and store them in any store. An inference engine picks the rules according to the requirements and runs them on input data or query. The system undertakes to always buy or sell health care at specified prices. The system buys and sells health care for its own account, inventory. Additionally, it buys and sells from its inventory. By purchasing health care directly from the exchange, the system can reduce administrative costs by 40%. There is no balance or surprise billing.

Abstract: The present invention is an intermediary through which health care services are purchased by the intermediary at wholesale prices from the health care system and auctioned by the intermediary via a distribution channel. Financial transactions are simultaneously settled through the invention via arbitrage. The intermediary is not a managed care organization, insurer, or reinsurer with respect to health insurance. It accepts financial risk and pays for the delivery of health care services. The present invention provides a method of receiving via the graphical user interface (GUI) a user selection of health care service(s) coupled with an offer of a price for a health care service. Determining, via a processor, the qualifying circumstances and matching reference data, whereby subjecting financial transactions to adjudication; consequentially lowering health care cost without compromising quality of health care.

Abstract: An electronic automated purchase care exchange network system for purchasing healthcare from the healthcare industry and as an intermediary, selling healthcare directly to the public. The system processes free and ubiquitous healthcare and insurance industry metadata to emulate industry protocols, learning from a set examples, applying training dataset to learning algorithms, applying ‘test’ set to assess the performance of fully-specified classifiers, for ensuring compliance during financial transactions. Accordingly, non-compliant bids are transformed into compliant proffers. Unlike health insurance coverage, the intermediary pays for the delivery of healthcare services, accepts financial risk for the delivery of healthcare services and establishes, operates or maintains an arrangement or contract with healthcare providers relating to (a) the healthcare services rendered by the providers, and (B) the amounts to be paid to the providers for such services.

Abstract: The present method and system discloses an improvement to the existing relative value unit (RVU) service provided by Medicare and Medicaid which provides a set (arbitrary) value for a medical service and is not flexible and does not change to reflect the most current charges and payments for a specific medical procedure or service. The present system is an options service unit (OSU) system and is based on the principle that monetary value, i.e. compensation, should vary with the varying resource costs for providing those services.