Method and system for processing transactions involving accounts for reimbursing medical expenses or patient responsible balances with multiple transaction substantiation modes

• US 7,680,679 B1
• Filed: 01/26/2007
• Issued: 03/16/2010
• Est. Priority Date: 06/11/2001
• Status: Active Grant

• Current Assignee: WEX Health, Inc. (WEX Inc.)
• Original Assignee: Evolution Benefits Incorporated (WEX Inc.)
• Inventors: Dallahan, Matthew J., Patricelli, Robert E., Rausch, Kent F.
• Primary Examiner(s): O'Connor; Gerald J.
• Assistant Examiner(s): Najarian; Lena
• Application Number:
  US11/698,026
• Time in Patent Office: 1,145 Days
• Field of Search: 705/2, 705/4, 705/39
• US Class Current: 705/2
• 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

The present invention relates to a method and system for processing transactions involving accounts for reimbursing medical expenses or patient responsible balances, wherein the accounts may be handled by multiple payors having multiple transaction substantiation requirements. Examples of such accounts include flexible spending accounts, health reimbursement arrangement accounts, medical savings account, health savings account and the like. The system and method of the present invention allow an employer that uses multiple payors for administering the aforementioned accounts to distinguish its employees based on their associated payors in order to determine the proper transaction substantiation requirement per each employee and associated payor without having required to collect payor data at the employee level.

Claims

1. A computer implemented method for processing a transaction involving an account for reimbursing qualified medical expenses and/or patient responsible balances (PRBs), comprising the steps of:

receiving enrollment data of participants electing to perform payment-card transactions using accounts for reimbursing qualified medical expenses and/or PRBs;

assigning a status to the participant from one of a first and second statuses;

receiving from a goods or service provider a request to authorize payment of a qualified medical expense and/or PRB against an account associated with a participant in connection with a first sales transaction between the participant and the goods or service provider;

in response to the participant'"'"'s assigned status being of the first status, electronically performing a real-time substantiation of the first sales transaction using a computerized system, authorizing payment of the qualified medical expense and/or PRB against the associated account, and communicating to the goods or service provider authorization of payment of the qualified medical expense and/or PRB against the associated account, wherein the communicating the authorization occurs subsequently to the real-time substantiation; and

in response to the participant'"'"'s assigned status being of the second status, communicating to the goods or service provider authorization of payment of the qualified medical expense and/or PRB against the associated account, effecting the payment of the qualified medical expense and/or PRB against the associated account, and electronically performing a retrospective substantiation of the first sales transaction using a computerized system, wherein the retrospective substantiation is performed subsequently to the communication of the authorization.

2. The computer implemented method of claim 1 wherein assigning the status to the participant comprises assigning the first status to the participant upon an expiration of a predetermined initial time period and a receipt of transaction data associated with the participant'"'"'s one or more sales transactions.

3. The computer implemented method of claim 1 wherein assigning the status to the participant comprises assigning the second status to the participant upon a receipt of an assignment of the retrospective substantiation to be performed with the participant.

4. The computer implemented method of claim 1 wherein assigning the status to the participant comprises assigning the second status to the participant when the participant is within a predetermined initial time period.

5. The computer implemented method of claim 1 wherein performing the real-time substantiation comprises:

receiving transaction data associated with the participant'"'"'s one or more sales transactions;

comparing the transaction data with the first sales transaction to find a match of one or more pieces of the transaction data with the first sales transaction; and

in response to the matching, removing the matched one or more transaction data pieces from the transaction data for future comparisons.

6. The computer implemented method of claim 1 wherein communicating to the goods or service provider comprises communicating to the goods or service provider authorization of payment of the qualified medical expense or PRB against the associated account prior to performing the retrospective substantiation.

7. The computer implemented method of claim 6 wherein performing the retrospective substantiation comprises:

receiving transaction data associated with the participant'"'"'s one or more sales transactions;

comparing the transaction data with the first sales transaction to find a match of one or more pieces of the transaction data with the first sales transaction; and

in response to the matching, removing the matched one or more transaction data pieces from the transaction data for future comparisons.

8. The computer implemented method of claim 7 wherein the participant'"'"'s one or more sales transactions have been serviced in a predetermined period of time prior to a date of receiving from the goods or service provider the request to authorize payment of the qualified medical expense and/or PRB.

9. The computer implemented method of claim 1 wherein performing the retrospective substantiation comprises:

receiving transaction data associated with the participant'"'"'s one or more sales transactions;

comparing the transaction data with the first sales transaction to find a match of one or more pieces of the transaction data with the first sales transaction; and

in response to no matching of any of the transaction data pieces with the first sales transaction, requesting additional information from the participant regarding the first sales transaction.

10. The computer implemented method of claim 1 further comprising issuing to the participants payment-cards linked to the accounts based on the enrollment data and receiving notices of activation of the issued payment-cards from the participants.

11. A computer implemented method for processing transactions involving accounts for reimbursing qualified medical expenses and/or patient responsible balances (PRBs), comprising:

receiving enrollment data of participants electing to perform payment-card transactions using accounts for reimbursing qualified medical expenses and/or PRBs;

assigning a first status to a first participant;

assigning a second status to a second participant, wherein the first status and second status cause different types of substantiation;

receiving from a first goods or service provider a request to authorize payment of a qualified medical expense and/or PRB against an account associated with a first participant in connection with a first sales transaction between the first participant and the first goods or service provider;

receiving from a second goods or service provider a request to authorize payment of a qualified medical expense and/or PRB against an account associated with a second participant in connection with a second sales transaction between the second participant and the second goods or service provider;

in response to the participant'"'"'s assigned status being of the first status, electronically performing a real-time substantiation of the first sales transaction using a computerized system, providing authorization of payment of the qualified medical expense and/or PRB against the associated account, and communicating to the goods or service provider authorization of payment of the qualified medical expense and/or PRB against the associated account, wherein the communicating the authorization occurs subsequently to the real-time substantiation; and

in response to the second participant'"'"'s assigned second status, electronically performing a second substantiation of the second sales transaction using a computerized system, the second substantiation being a retrospective substantiation of the second sales transaction, and communicating to the second goods or service provider authorization of payment of the qualified medical expense and/or PRB against the account associated with the second participant, wherein the retrospective substantiation is performed subsequently to the communication of the authorization.

12. The computer implemented method of claim 11 wherein performing the first substantiation comprises:

receiving transaction data associated with the first participant'"'"'s one or more sales transactions;

comparing the transaction data with the first sales transaction to find a match of one or more pieces of the transaction data with the first sales transaction; and

in response to the matching, removing the matched one or more transaction data pieces from the transaction data for future comparisons.

13. The computer implemented method of claim 11 wherein performing the second substantiation comprises:

receiving transaction data associated with the second participant'"'"'s one or more sales transactions;

comparing the transaction data with the second sales transaction to find a match of one or more pieces of the transaction data with the second sales transaction; and

in response to the matching, removing the matched one or more transaction data pieces from the transaction data for future comparisons.

14. The computer implemented method of claim 11 wherein the second participant'"'"'s one or more sales transactions have been serviced a predetermined period of time prior to a date of receiving from the second goods or service provider the second request to authorize payment of the qualified medical expense and/or PRB.

15. The computer implemented method of claim 11 further comprising issuing to the participants payment-cards linked to the accounts based on enrollment data and receiving notices of activation of the issued payment-cards from the participants.

16. The computer implemented method of claim 15 further comprising creating eligibility reports of the participants based on the received notices of activation and providing the eligibility reports to all the payors in the list.

17. The computer implemented method of claim 11 wherein the request to authorize payment is based on one of the participants using one of the issued payment-cards at the goods or service provider.

18. The computer implemented method of claim 11 wherein the first goods or service provider and the second goods or service provider are the same.

19. The computer implemented method of claim 11 wherein the first goods or service provider and the second goods or service provider are different.

20. The computer implemented method of claim 11 wherein the participants are members of a single organization.