Method and system for determining healthcare eligibility

• US 20060149603A1
• Filed: 09/20/2005
• Published: 07/06/2006
• Est. Priority Date: 01/04/2005
• Status: Abandoned Application

• Current Assignee: Visa USA, Inc. (Visa, Inc.)
• Original Assignee: Visa USA, Inc. (Visa, Inc.)
• Inventors: Nguyen, Loc, Pourfallah, Stacy, Patterson, Barbara, Pruitt, Janet
• Application Number:
  US11/230,743
• Publication Number:
  US 20060149603A1
• Time in Patent Office: Days
• US Class Current: 705/4
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 40/08 Insurance
• CPC Class Codes: G16H 10/65 stored on portable record carriers, e.g. on smartcards, RFID tags or CD

Abstract

A method for determining healthcare insurance coverage eligibility is disclosed. The method includes receiving patient information at a terminal operated by a healthcare provider. An eligibility authorization request message is created, and is sent to an acquirer processor, where the acquirer processor sends the eligibility authorization request message to a transaction processing system, which routes the eligibility authorization request message to a healthcare processor. A response message is then received.

Claims

1. A method comprising:

receiving patient information at a terminal operated by a healthcare provider;

creating a non-financial eligibility authorization request message which relates to healthcare insurance coverage using the patient information;

sending the eligibility authorization request message to an acquirer processor or its designated third party processor, wherein the acquirer processor sends the authorization request message to a transaction processing system, and wherein the authorization request message is evaluated in view of information from an issuer processor or a healthcare processor; and

receiving a response message in response to the eligibility authorization request message.

2. The method of claim 1 wherein the eligibility authorization request message is routed from the transaction processing system to the healthcare processor via the issuer processor.

3. The method of claim 1 wherein creating the authorization request message comprises adding data to a data field to indicate that the authorization request message relates to a non-financial eligibility request transaction.

4. The method of claim 1 wherein the healthcare processor is operated by an insurance carrier, the issuer processor or a third-party processor.

5. The method of claim 1 wherein the response message relates to whether or not the patient is eligible for a healthcare related good or service.

6. The method of claim 1 wherein the patient information is at least in part obtained from a portable consumer device, wherein the portable consumer device is in the form of a card or other portable consumer device.

7. The method of claim 1 further comprising receiving a service code at the terminal.

8. The method of claim 1 wherein the transaction processing system is part of a payment processing network.

9. The method of claim 1 further comprising displaying or printing information relating to the response message at the terminal.

10. A computer readable medium comprising:

code for receiving patient information at a terminal operated by a healthcare provider;

code for creating a non-financial eligibility authorization request message which relates to healthcare insurance coverage using the patient information;

code for sending the eligibility authorization request message to an acquirer processor, wherein the acquirer processor sends the authorization request message to a transaction processing system, and wherein the authorization request message is evaluated in view of information from an issuer processor or a healthcare processor; and

code for receiving a response message in response to the eligibility authorization request message.

11. The medium of claim 10 wherein the authorization request message is routed from the transaction processing system to the healthcare processor via the issuer processor.

12. The medium of claim 10 further comprising code for adding data to a data field to indicate that the eligibility authorization request message relates to a non-financial transaction.

13. The medium of claim 10 wherein the healthcare processor is operated by an insurance carrier or entity on behalf of the insurance carrier.

14. The medium of claim 10 wherein the response message relates to whether or not the patient is eligible for a healthcare related good or service.

15. The medium of claim 10 wherein the patient information is at least in part obtained from a from a portable consumer device, wherein the portable consumer device is in the form of a card or another portable consumer device.

16. The medium of claim 10 further comprising code for receiving a service code at the terminal.

17. A terminal comprising the computer readable medium of claim 10.

18. A system comprising the computer readable medium of claim 10.

19. A method comprising:

receiving patient information comprising a patient identification number at a terminal operated by a healthcare provider, wherein the patient information is stored or displayed in a portable consumer device in the form of a card;

creating a non-financial eligibility authorization request message which relates to healthcare insurance coverage using the patient information, wherein creating the eligibility authorization request message comprises adding data to a data field to indicate that the authorization request message relates to a non-financial eligibility transaction;

sending the eligibility authorization request message to an acquirer processor, wherein the acquirer processor sends the authorization request message to a transaction processing system, and an issuer processor, and then optionally to a healthcare processor; and

receiving a response message from the healthcare processor or the issuer processor.

20. The method of claim 19 further comprising:

displaying or printing information relating to the response message at the terminal