System and method for processing flexible spending account transactions

• US 20020198831A1
• Filed: 06/11/2001
• Published: 12/26/2002
• Est. Priority Date: 06/11/2001
• Status: Active Grant

• Current Assignee: WEX Health, Inc. (WEX Inc.)
• Original Assignee: Evolution Benefits Incorporated (WEX Inc.)
• Inventors: Byrd, Christopher M., Patricelli, Robert E., Chabot, Paul L.
• Granted Patent: US 7,174,302 B2
• Time in Patent Office: Days
• US Class Current: 705/40
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 20/10 specially adapted for electronic funds transfer [EFT] systems; specially adapted for home banking systems
• CPC Class Codes: G06Q 20/102 Bill distribution or payments
• CPC Class Codes: G06Q 20/14 specially adapted for billing systems
• CPC Class Codes: G06Q 20/227 characterised in that multiple accounts are available, e.g. to the payer
• CPC Class Codes: G06Q 20/342 Cards defining paid or billed services or quantities
• CPC Class Codes: G06Q 20/40 Authorisation, e.g. identification of payer or payee, verification of customer or shop credentials; Review and approval of payers, e.g. check credit lines or negative lists
• CPC Class Codes: G06Q 30/04 Billing or invoicing
• CPC Class Codes: G06Q 40/08 Insurance
• CPC Class Codes: G07F 17/0092 for assembling and dispensing of pharmaceutical articles medical dispensers for private use, A61J7/00
• CPC Class Codes: G07F 7/025 by means, e.g. cards, providing billing information at the time of purchase, e.g. identification of seller or purchaser, quantity of goods delivered or to be delivered
• CPC Class Codes: G16H 10/60 for patient-specific data, e.g. for electronic patient records

Abstract

A system and method are provided for processing flexible spending account transactions involving a plurality of pharmacies, a service provider, one or more pharmacy benefits managers (“PBMs”), and individuals having flexible spending accounts (“FSAs”) and stored value cards for debiting their FSAs. The service provider maintains a PBM transaction database; receives from a pharmacy an authorization request at the time of purchase; queries the PBM transaction database for a matching transaction in response to the authorization request; and authorizes payment of the patient responsible balance to be automatically debited against the respective FSA at the time of purchase.

Claims

1. A method for processing flexible spending account transactions, comprising the steps of:

storing data received from at least one payor indicative of transactions involving adjudicated claims and associated patient responsible balances (PRBs) in a payor transaction database;

receiving from a goods or service provider a request to authorize payment of a PRB against a flexible spending account (FSA) associated with a customer in connection with a sales transaction between said customer and the goods or service provider;

querying the payor transaction database for at least one transaction involving an adjudicated claim and associated PRB, and that matches said sales transaction;

determining whether to authorize payment of the PRB against the FSA based upon the query of the payor transaction database; and

communicating to the goods or service provider either authorization of payment of the PRB against the FSA or denial of the request to authorize payment.

2. A method as recited in claim 1, wherein the authorization request includes a card holder identifier and a requested amount.

3. A method as recited in claim 2, wherein the authorization request further includes a merchant identifier, a merchant category code, and date and time of the transaction.

4. A method as recited in claim 2, further comprising the step of associating the data received from the at least one payor with at least one card holder identifier, and querying the payor transaction database based on the card holder identifier.

5. A method as recited in claim 1, further comprising the steps of storing data received from a health care administrator in an eligibility database, and verifying eligibility for the customer based upon querying the eligibility database.

6. A method as recited in claim 5, further comprising the step of updating the eligibility database on a periodic basis.

7. A method as recited in claim 4, further comprising the step of mapping at least one participant identifier to a plurality of card holder identifiers.

8. A method as recited in claim 1, wherein the goods or service provider is a pharmacy, and the payor is a PBM.

9. A method as recited in claim 1, wherein the matching of the sales transaction to the at least one transaction in the payor transaction database is based on the amount of the PRB in the authorization request.

10. A method as recited in claim 1, wherein the step of querying the payor transaction database for the at least one sales transaction further includes the step of determining whether multiple transactions that are associated with a respective customer exist in the payor transaction database.

11. A method as recited in claim 9, wherein the step of querying the payor transaction database for the at least one sales transaction further includes the step of summing the PRBs of multiple transactions associated with a respective customer in the payor transaction database to yield a summed amount, and comparing the summed amount to the PRB of the authorization request.

12. A method as recited in claim 9, wherein the step of querying the payor transaction database for the at least one sales transaction further includes the step of comparing the PRB of the authorization request against a plurality of different combinations of PRBs associated with a respective customer in the payor transaction database.

13. A method as recited in claim 9, wherein the step of querying the payor transaction database for the at least one sales transaction further includes the step of comparing the PRB of the authorization request against the sum of all PRBs associated with a respective customer on a respective date.

15. A system as recited in claim 14, wherein the first means includes a computer memory.

16. A system as recited in claim 14, wherein the second means includes a modem.

17. A system as recited in claim 14, wherein the third means includes a processor.

18. A system as recited in claim 14, wherein the fourth means includes a processor.

19. A system as recited in claim 14, wherein the fifth means includes a modem.

20. A system as recited in claim 14, further comprising at least one housing for containing and operatively connecting the first, second, third, fourth, and fifth means.

21. A system as recited in claim 14, wherein the goods or service provider is a pharmacy, and the payor is a PBM.

22. A system as recited in claim 14, wherein the authorization request of the second means includes at least a card holder identifier and a requested PRB amount.

23. A system as recited in claim 22, further comprising means for associating the data received from the at least one payor with at least one card holder identifier, and wherein the third means queries the payor transaction database based on the at least one card holder identifier.

24. A system as recited in claim 14, wherein the matching of the sales transaction to the transaction in the payor transaction database is based on the amount of the PRB in the request.

25. A system as recited in claim 14, wherein the third means determines whether multiple transactions that are associated with the respective customer exist in the payor transaction database.

26. A system as recited in claim 25, further comprising means for summing the PRBs of multiple transactions associated with a respective customer in the payor transaction database to yield a summed amount, and comparing the summed amount to the PRB of the authorization request.

27. A system as recited in claim 25, further comprising means for comparing the PRB of the authorization request against a plurality of different combinations of PRBs associated with a respective customer in the payor transaction database.

28. A system as recited in claim 25, further comprising means for comparing the PRB of the authorization request against a sum of all PRBs associated with a respective customer on a respective date in the payor transaction database.

30. A system as recited in claim 29, wherein the matching of the sales transaction to the transaction in the payor transaction database is based on the amount of the PRB in the request.

31. A system as recited in claim 29, wherein the at least one processor is further configured to determine whether multiple transactions that are associated with the respective customer exist in the payor transaction database.

32. A system as recited in claim 31, wherein the at least one processor is further configured to determine whether there is at least one transaction in the payor transaction database that matches the sales transaction of the authorization request by summing the PRBs of multiple transactions associated with a respective customer in the payor transaction database to yield a summed amount, and comparing the summed amount to the PRB of the authorization request.

33. A system as recited in claim 31, wherein the at least one processor is further configured to determine whether there is at least one transaction in the payor transaction database that matches the sales transaction of the authorization request by comparing the PRB of the authorization request against a plurality of different combinations of PRBs associated with a respective customer in the payor transaction database.

34. A system as recited in claim 31, wherein the at least one processor is further configured to determine whether there is at least one transaction in the payor transaction database that matches the sales transaction of the authorization request by comparing the PRB of the authorization request against a sum of all PRBs associated with a respective customer on a respective date.

14. A system for processing flexible spending account transactions, comprising:

first means for storing data received from at least one payor indicative of transactions involving adjudicated claims and associated patient responsible balances (PRBs) in a payor transaction database;

second means for receiving from a goods or service provider a request to authorize payment of a PRB against a FSA associated with a customer in connection with a sales transaction between said customer and the goods or service provider;

third means for querying the payor transaction database for at least one transaction involving an adjudicated claim and associated PRB and matching said sales transaction; and

fourth means for determining whether to authorize payment of the PRB against the FSA based upon the query of the payor transaction database; and

fifth means for communicating to the goods or service provider either authorization of payment of the PRB against the FSA or denial of the request to authorize payment.

29. A system for processing flexible spending account transactions, comprising:

(a) at least one memory configured for storing a program and a payor transaction database of transactions involving adjudicated claims and associated patient responsible balances (PRBs); and

(b) at least one processor in communication with the at least one memory, wherein the at least one processor is configured for;

(i) receiving from a goods or service provider a request to authorize payment of a PRB against a FSA associated with a customer in connection with a sales transaction between said customer and the goods or service provider;

(ii) querying the payor transaction database for at least one transaction involving an adjudicated claim and associated PRB and matching said sales transaction;

(iii) determining whether to authorize payment of the PRB against the FSA based upon the query of the payor transaction database; and

(iv) communicating to the goods or service provider either authorization of payment of the PRB against the FSA or denial of the request to authorize payment.