Method for reimbursing administrators of payments

• US 7,567,938 B1
• Filed: 06/22/2006
• Issued: 07/28/2009
• Est. Priority Date: 06/22/2005
• Status: Active Grant

• Current Assignee: Arch Capital Group Limited
• Original Assignee: Arch Insurance Group Incorporated (Arch Capital Group Limited)
• Inventors: Frederickson, F. Scott, LaRusso, David
• Primary Examiner(s): Abdi; Kambiz
• Assistant Examiner(s): LIVERSEDGE, JENNIFER L
• Application Number:
  US11/472,933
• Time in Patent Office: 1,132 Days
• Field of Search: 705/39
• US Class Current: 705/39
• CPC Class Codes: G06Q 10/087 Inventory or stock management, e.g. order filling, procurement or balancing against orders
• CPC Class Codes: G06Q 20/10 specially adapted for electronic funds transfer [EFT] systems; specially adapted for home banking systems
• CPC Class Codes: G06Q 30/0185 Product, service or business identity fraud
• CPC Class Codes: G06Q 40/02 Banking, e.g. interest calculation or account maintenance credit or loans G06Q40/03
• CPC Class Codes: G06Q 40/08 Insurance
• CPC Class Codes: G06Q 50/18 Legal services

Abstract

A loss ledger system to process third party fund requests on a daily basis, track historical requests, process validation on each request, maintain suspense/escrow and loss ledgers, and provide reconciliation assistance for accounting and claims processing departments. Additionally, the loss ledger system provides management reports, interfaces, security, audit and control and data conversion to facilitate minimizing escrowed resources, fraudulent activity and clerical errors.

Claims

1. An insurance loss ledger management system, wherein the insurance loss ledger management system communicates with third party administrators (TPAs) and banks via a network, and wherein the system comprises:

(a) a memory storing an instruction set and data related to a plurality of insurance policy holders; and

(b) a processor for running the instruction set, the processor being in communication with the memory and the network, wherein the processor is operative to facilitate processing insurance third party administrator (TPA) fund requests by an insurance carrier on a periodic basis by;

(i) maintaining an escrow account with a balance at a first bank to provide payments to an insurance TPA;

(ii) receiving a plurality of insurance TPA fund requests from the insurance TPA, each insurance TPA fund request being for a daily total related to a plurality of payees based on insurance policies between the plurality of insurance policy holders and the insurance carrier;

(iii) approving the insurance TPA fund requests based upon certain criteria, wherein the criteria is data associated with a claim payment check issued by the insurance TPA, wherein the data includes a check number, amount, date and claim number;

(iv) providing daily instructions to a second bank to transfer funds to the escrow account to minimize the balance based on approval of the insurance TPA fund requests, the funds being equal to the approved insurance TPA fund request total and transferred daily; and

(v) monitoring payment and clearance of the amounts associated with the approved insurance TPA fund requests from the escrow account to insure the balance is sufficient.

2. An insurance loss ledger management system as recited in claim 1, wherein the processor is further operative to track historical activity related to the insurance TPA.

3. An insurance loss ledger management system as recited in claim 1, wherein the processor is further operative to maintain an escrow account balance and loss ledger in real-time.

4. An insurance loss ledger management system as recited in claim 3, wherein the processor is further operative to note approval of the insurance TPA fund request to prevent a second fund transfer for the insurance TPA fund request.

5. An insurance loss ledger management system as recited in claim 3, wherein the processor is further operative to note transfer of funds for the insurance TPA fund request to prevent a second fund transfer for the insurance TPA fund request.

6. An insurance loss ledger management system as recited in claim 1, wherein the processor is further operative to conduct pre-fund requests for anticipated insurance TPA fund requests above a certain threshold.

7. An insurance loss ledger management system as recited in claim 1, wherein the processor is further operative to reconcile reports from the insurance TPA, the first bank and the second bank.

8. An insurance loss ledger management system as recited in claim 7, wherein the processor is further operative to reject one of the insurance TPA fund requests upon the criteria that a fund request for a certain related claim having already been approved and funded.

9. A method for implementing a loss ledger for an insurance carrier in a network in communication with banks, third party administrators (TPAs), and the insurance carrier, the method comprising the steps of:

(a) establishing an escrow account at a bank for use by the insurance carrier and an insurance third party administrator (TPA), wherein a bank client computer of the bank is in communication with a carrier server computer of the insurance carrier via the network;

(b) receiving a funding request at the carrier server from an insurance client computer of the insurance TPA via the network, the fund request being an electronic data file including a claim number, an amount, a check number and a check date;

(c) approving the fund request by the carrier server based upon the claim number, the amount, the check number and the check date;

(d) providing funds to the bank for the escrow account equal to the amount; and

(e) monitoring clearance of the funds from the escrow account by the carrier server such that a second fund request for the same claim number, amount, check number or date is rejected, wherein the monitoring step includes daily tracking of a total of outstanding payments to be made from the escrow account so that a balance of the escrow account is minimized.

10. An insurance loss ledger management system, wherein the insurance loss ledger management system communicates with third party administrators (TPAs) and banks via a network, and wherein the system comprises

(a) a memory storing an instruction set and data related to a plurality of insurance policy holders;

and

(b) a processor for running the instruction set, the processor being in communication with the memory and the network, wherein the processor is operative to facilitate processing insurance third party administrator (TPA) fund requests by an insurance carrier on a periodic basis by;

(i) maintaining an escrow account with a balance at a first bank to provide payments to an insurance TPA;

(ii) receiving a plurality of insurance TPA fund requests from the insurance TPA, each insurance TPA fund request being for a daily total related to a plurality of payees based on insurance policies between the plurality of insurance policy holders and the insurance carrier;

(iii) approving the insurance TPA fund requests based upon certain criteria, wherein the criteria is data associated with a claim payment check issued by the insurance TPA, wherein the data includes a check number, amount, date and claim number;

(iv) providing daily instructions to a second bank to transfer funds to the escrow account to minimize the balance based on approval of the insurance TPA fund requests, the funds being equal to the approved insurance TPA fund request total and transferred daily;

(v) monitoring payment and clearance of the amounts associated with the approved insurance TPA fund requests from the escrow account to insure the balance is sufficient; and

(vi) rejecting one of the insurance TPA fund requests upon the criteria that a fund request represents a certain related insurance TPA fund request that has already been approved and funded.

11. An insurance loss ledger management system as recited in claim 10, wherein the processor is further operative to reconcile reports from the insurance TPA, the first bank and the second bank.

12. An insurance loss ledger management system as recited in claim 10, wherein the processor is further operative to track historical activity related to the insurance TPA.

13. An insurance loss ledger management system as recited in claim 10, wherein the processor is further operative to maintain an escrow account balance and loss ledger related to same in substantially real-time.

14. An insurance loss ledger management system as recited in claim 13, wherein the processor is further operative to note approval of the insurance TPA fund request to prevent a second fund transfer for the insurance TPA fund request.

15. An insurance loss ledger management system as recited in claim 13, wherein the processor is further operative to note transfer of funds for the insurance TPA fund request to prevent a second fund transfer for the insurance TPA fund request.