Health care eligibility verification and settlement systems and methods

• US 20050015280A1
• Filed: 05/13/2004
• Published: 01/20/2005
• Est. Priority Date: 06/11/2002
• Status: Abandoned Application

• Current Assignee: First Data Corporation (Fiserv Incorporated)
• Original Assignee: First Data Corporation (Fiserv Incorporated)
• Inventors: Gabel, Judi, Winking, Bradley, Nauman, George, Turek, Judy, Bartlett, Robyn, Kennedy, Beverly
• Application Number:
  US10/846,947
• Publication Number:
  US 20050015280A1
• Time in Patent Office: Days
• US Class Current: 705/2
• CPC Class Codes: G06Q 20/02 involving a neutral party, e.g. certification authority, notary or trusted third party [TTP]
• CPC Class Codes: G06Q 20/04 Payment circuits
• CPC Class Codes: G06Q 20/346 Cards serving only as information carrier of service
• CPC Class Codes: G06Q 30/06 Buying, selling or leasing transactions
• CPC Class Codes: G06Q 40/08 Insurance
• CPC Class Codes: G06Q 99/00 Subject matter not provided for in other groups of this subclass
• CPC Class Codes: G07F 7/1008 Active credit-cards provided with means to personalise their use, e.g. with PIN-introduction/comparison system

Abstract

A method of verifying health insurance coverage eligibility for a patient includes receiving at a host computer system a message from a provider. The message includes a request for an eligibility and coverage information packet. The message identifies at least the patient and the provider. The method also includes using at least a portion of the information in the request to locate a payer associated with the patient and sending a message to a computing system of the payer. The message comprises a request to return to the host computer system the eligibility and coverage information packet. The method also includes receiving the eligibility and coverage information packet from the computing system of the payer and sending the packet to the provider.

Claims

1. A health care eligibility and settlement presentation instrument, comprising:

an information encoding region from which information is readable by a point-of-sale device, the information encoding region having encoded therein one or more account designators that relate to at least two accounts, a first account being an eligibility account and a second account being a payment account, wherein transmission of a first account designator to a health care eligibility verification system initiates a process that results in the return of a health care eligibility verification packet to a provider, and wherein transmission of a second account designator initiates a process that results in payment of services to the provider.

2. The health care eligibility and settlement presentation instrument of claim 1, wherein the first and second account designators are the same.

3. The health care eligibility and settlement presentation instrument of claim 1, wherein the first and second account designators are different.

4. The health care eligibility and settlement presentation instrument of claim 1, wherein the presentation instrument comprises a selection from the group consisting of plastic card, credit card, debit card, stored value card, private label card, bar coded card, smart cards, and DDA payment (bank account direct debit) card.

5. The health care eligibility and settlement presentation instrument of claim 1, wherein the process that results in payment of services to the provider relates to a selection from the group consisting of a credit card settlement, a debit card settlement, a flexible spending account settlement, a health savings account settlement, health reimbursement account settlement, medical savings account settlement, transportation account settlement, parking settlement, dependent care settlement and a claim settlement.

6. A method of verifying health insurance coverage eligibility for a patient, comprising:

receiving at a host computer system a message from a provider, wherein the message comprises a request for an eligibility and coverage information packet and wherein the message identifies at least the patient and the provider;

using at least a portion of the information in the request to locate a payer associated with the patient;

sending a message to a computing system of the payer, wherein the message comprises a request to return to the host computer system the eligibility and coverage information packet;

receiving the eligibility and coverage information packet from the computing system of the payer; and

sending the packet to the provider.

7. The method of claim 6, wherein sending the packet to the provider comprises sending the packet to the provider in a manner identified in the request from the provider.

8. The method of claim 6, wherein sending the packet to the provider comprises sending the packet to the provider according to a primary means pre-selected by the provider.

9. The method of claim 6, wherein sending the packet to the provider comprises sending the packet to the provider according to a secondary means pre-selected by the provider.

10. The method of claim 6, wherein sending the packet to the provider comprises sending the packet by a means selected from the group consisting of facsimile, electronic message, Internet posting, and IVR system.

11. A system for verifying health insurance coverage eligibility for a patient, comprising:

a host computer system;

means for communicating with providers; and

means for communicating with payers;

wherein the host computer system is programmed to;

receive a message from a provider, wherein the message comprises a request for an eligibility and coverage information packet and wherein the message identifies at least the patient and the provider;

use at least a portion of the information in the request to locate a payer associated with the patient;

send a message to a computing system of the payer, wherein the message comprises a request to return to the host computer system the eligibility and coverage information packet;

receive the eligibility and coverage information packet from the computing system of the payer; and

send the packet to the provider.

12. The system of claim 11, wherein the host computer system is further programmed to send the packet to the provider in a manner identified in the request from the provider.

13. The system of claim 11, wherein the host computer system is further programmed to send the packet to the provider according to a primary means pre-selected by the provider.

14. The system of claim 11, wherein the host computer system is further programmed to send the packet to the provider according to a secondary means pre-selected by the provider.

15. The system of claim 11, wherein the host computer system is further programmed to send the packet by a means selected from the group consisting of facsimile, electronic message, Internet posting, and IVR system.

16. A method of settling a transaction relating to health care, comprising:

receiving at a host computer system a transmission from a provider device, wherein the transmission comprises account identifier information from a member'"'"'s health care benefits presentation instrument;

using the account information to locate multiple balances relating to the member;

initially aggregating the balances and comparing a transaction to the resulting total;

further analyzing each balance independently and comparing each independent balance to the transaction total; and

transmitting an approval code to the provider device based on the comparison.

17. The method of claim 16, further comprising:

thereafter segmenting the transaction into at least two parts and processing the parts as two different settlement transactions.

18. The method of claim 17, wherein one of the parts comprises a selection from the group consisting of flexible spending account settlement transaction and health care spending account settlement transaction and the other comprises a selection from the group consisting of debit card transaction, credit card transaction, and covered service claim settlement transaction.