Automated system for filing prescription drug claims

• US 7,739,127 B1
• Filed: 09/23/2004
• Issued: 06/15/2010
• Est. Priority Date: 09/23/2004
• Status: Active Grant

• Current Assignee: Hall Benefits LLC
• Original Assignee: HALL Barckley, LLC
• Inventors: Hall, Stephen Don
• Primary Examiner(s): O'Connor; Gerald J.
• Assistant Examiner(s): Pauls; John A
• Application Number:
  US10/948,779
• Time in Patent Office: 2,091 Days
• Field of Search: 705/2, 705/4
• US Class Current: 705/2
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 30/06 Buying, selling or leasing transactions
• CPC Class Codes: G16H 20/10 relating to drugs or medications, e.g. for ensuring correct administration to patients

Abstract

An automated system and method for filing prescription drug claims which includes a point of service terminal which accepts a payment system access card for payment for a purchase of a service and/or product by a customer, where at least part of the purchase is reimbursable by a third party payor. The point of service terminal creates a purchase transaction and during the transaction electronically captures pertinent claim information including a claim authorization or approval number. The point of service terminal uses the pertinent claim information to update a claim records database. The claim records database is accessed by the third party payor and the pertinent claim information is validated. The applicable reimbursement amount, which is determined by the third party payor, is issued as a credit to the customer payment card account or a customer bank account or as a check.

Claims

1. A method of filing a prescription claim within a health insurance indemnity system, wherein an insurance subscriber files a prescription claim by using a payment card in a purchase transaction for a prescription, the method comprising:

issuing said payment card having a payment card number to said insurance subscriber;

linking said payment card number to an insurance contract number for said insurance subscriber within a database of an insurance company or third party payor covering said insurance subscriber;

said insurance company or third party payor issuing a claim authorization or approval number for said prescription for said insurance subscriber to a specific provider prior to conducting said purchase transaction for said prescription;

said insurance subscriber using said payment card to pay in full for said prescription as part of said purchase transaction;

incorporating said claim authorization or approval number and other pertinent claim information as part of purchase transaction input data for said prescription;

providing a point of service terminal for electronically capturing said purchase transaction input data for said prescription;

wherein said purchase transaction input data resides in a data storage device;

wherein the data storage device comprises a bar code label;

said point of service terminal having a computer connection to a claim records database for updating said claim records database with said pertinent claim information thereby causing an updated claim records database;

wherein said pertinent claim information includes at least said claim authorization or approval number;

said insurance company or third party payor accessing said updated claim records database through an Internet or other computer connection and validating said pertinent claim information contained therein;

said insurance company or third party payor accepting said updated claim records database as a claim for reimbursement from said insurance subscriber for said prescription upon validating said pertinent claim information contained in said updated claim records database.

2. The method of claim 1 wherein said prescription comprises prescription drugs, prescription healthcare equipment, prescribed treatments, or combinations thereof.

3. The method of claim 1 wherein said specific provider is selected from the group consisting of a drug manufacturer, a healthcare equipment manufacturer, a drug distributor, a healthcare distributor, a physician, and combinations thereof.

4. The method of claim 1 wherein said purchase transaction input data resides in a data storage device selected from the group consisting of a magnetic stripe, a chip, a provider database, a third party payor database, and combinations thereof.

5. The method of claim 1 wherein said claim records database is said service provider'"'"'s claim records database.

6. The method of claim 1 wherein said claim records database is said insurance company'"'"'s or third party payor'"'"'s claim records database.

7. The method of claim 1 wherein said point of service terminal accesses said claim records database using an Internet connection to a node containing said claim records database.

8. The method of claim 1 wherein said claim records database is a database that resides on a computer of said specific provider.

9. The method of claim 1 wherein said claim records database is a database that resides on a computer of said insurance company or third party payor.