System and method for processing flexible spending account transactions
First Claim
1. A method for processing a request to authorize payment against an account for reimbursing patient responsible balances (PRBs), comprising the steps of:
- receiving from at least one payor data indicative of transactions involving adjudicated claims and associated PRBs;
storing in a payor transaction database said data received from the at least one payor;
receiving from a goods or service provider a request to authorize payment of a PRB against said account, wherein said account is associated with a customer in connection with a sales transaction between said customer and the goods or service provider; and
initiating a substantiation process for the payment to the goods or service provider for the sales transaction prior to the authorization of the payment for the sales transaction, the substantiation process comprising;
querying the payor transaction database;
in the event that the payor transaction database contains transaction information of at least one transaction that matches said sales transaction, matching the transaction information to the sales transaction, then communicating to the goods or service provider authorization for payment of the PRB against the account, and settling the authorized payment of the PRB against the account; and
in the event that the payor transaction database does not contain transaction information that matches said sales transaction, communicating to the goods or service provider a denial of payment of the payment of the PRB against the account.
11 Assignments
0 Petitions
Accused Products
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.
216 Citations
46 Claims
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1. A method for processing a request to authorize payment against an account for reimbursing patient responsible balances (PRBs), comprising the steps of:
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receiving from at least one payor data indicative of transactions involving adjudicated claims and associated PRBs; storing in a payor transaction database said data received from the at least one payor; receiving from a goods or service provider a request to authorize payment of a PRB against said account, wherein said account is associated with a customer in connection with a sales transaction between said customer and the goods or service provider; and initiating a substantiation process for the payment to the goods or service provider for the sales transaction prior to the authorization of the payment for the sales transaction, the substantiation process comprising; querying the payor transaction database; in the event that the payor transaction database contains transaction information of at least one transaction that matches said sales transaction, matching the transaction information to the sales transaction, then communicating to the goods or service provider authorization for payment of the PRB against the account, and settling the authorized payment of the PRB against the account; and in the event that the payor transaction database does not contain transaction information that matches said sales transaction, communicating to the goods or service provider a denial of payment of the payment of the PRB against the account. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 35, 36, 37, 38)
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14. A system for processing a request to authorize payment against an account for reimbursing patient responsible balances (PRBs), comprising:
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first means for storing in a payor transaction database data received from at least one payor indicative of transactions involving adjudicated claims and associated PRBs; second means for receiving from a goods or service provider a request to authorize payment of a PRB against said account, wherein said account is associated with a customer in connection with a sales transaction between said customer and the goods or service provider; third means for initiating a substantiation process for the payment to the goods or service provider for the sales transaction prior to the authorization of the payment for the sales transaction and querying the payor transaction database for at least one transaction that matches said sales transaction; fourth means for matching the at least one transaction to the sales transaction, authorizing payment of the PRB against the account, and settling the authorized payment of the PRB against the account; fifth means for then communicating to the goods or service provider authorization for the payment of the PRB against the account and if the payor transaction database does not contain the at least one transaction that matches said sales transaction, communicating to the goods or service provider a denial of the payment of the PRB against the account. - View Dependent Claims (15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 39, 40, 41)
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29. A system for processing a request to authorize payment against an account for reimbursing patient responsible balances (PRBs), comprising:
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at least one memory configured for storing a program and a payor transaction database of transactions it involving adjudicated claims and associated PRBs; and at least one processor in communication with the at least one memory, wherein the at least one processor is configured for; receiving from a goods or service provider a request to authorize payment of a PRB against said account, wherein said account is associated with a customer in connection with a sales transaction between said customer and the goods or service provider; and initiating a substantiation process for the payment to the goods or service provider for the sales transaction prior to the authorization of the payment for the sales transaction, the substantiation process comprising; querying the payor transaction database; in the event that the payor transaction database contains transaction information of at least one transaction that matches said sales transaction, matching the transaction information to the sales transaction, then communicating to the goods or services provider authorization for payment of the PRB against the account, settling the authorized payment of the PRB against the account; and in the event that the payor transaction database does not contain transaction information that matches said sales transaction, communicating to the goods or service provider a denial of payment of the payment of the PRB against the account. - View Dependent Claims (30, 31, 32, 33, 34, 42, 43, 44, 45, 46)
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Specification