Benefit plan intermediary

• US 7,739,129 B2
• Filed: 04/10/2006
• Issued: 06/15/2010
• Est. Priority Date: 04/10/2006
• Status: Active Grant

• Current Assignee: Accenture Global Services Limited (Accenture PLC)
• Original Assignee: Accenture Global Services GmbH (Accenture PLC)
• Inventors: Cornelius, Richard D., McCaghy, Loren E. Jr., Hamilton, Neville Q., Sweetland, Christopher L., Nunn, Charles A.
• Primary Examiner(s): Gilligan; Luke
• Assistant Examiner(s): SOREY, ROBERT A
• Application Number:
  US11/401,764
• Publication Number:
  US 20070239493A1
• Time in Patent Office: 1,527 Days
• Field of Search: 705/4, 705/2
• US Class Current: 705/2
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• 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 40/08 Insurance

Abstract

A method may receive data comprising a request to assure payment for a transaction with a consumer, the transaction being associated with a provision of a service or a sale of a product. Thereafter, it may be determined whether payment of at least a portion of the transaction will be covered by a benefit plan associated with the consumer, and additionally, whether the consumer is able to pay for at least a portion of the transaction not covered by the benefit plan. Data is then transmitted authorizing the transaction if a predetermined amount of the transaction will be covered by at least one of the benefit plan or the consumer. Related apparatuses, computer program products, and computer systems are also described.

Claims

1. A computer-implemented method comprising:

receiving, by a computer and from a point of service (POS) device, a pre-authorization request to assure payment for a predetermined amount of a transaction with a consumer prior to a provider undertaking the transaction, the transaction being associated with a provision of a healthcare service, a sale of a healthcare product, or a lease of a healthcare product;

automatically generating, by the computer, prior to undertaking the transaction, a ranking of benefit plans and benefit savings accounts associated with the consumer, wherein automatically generating the ranking further comprises determining at least whether a primary member of a particular benefit plan is the consumer, a spouse of the consumer, or a partner of the consumer, whether a particular benefit plan is employer sponsored, and whether a particular benefit plan includes a primacy provision;

automatically determining, by the computer, an amount of the transaction that is covered by the benefit plans associated with the consumer based on sequentially sending a benefit plan payment request to one or more payment sources associated with each of the benefit plans, according to the ranking of the benefit plans, until the computer has determined that either at least the predetermined amount of the transaction is covered by the benefit plans or until each of the benefit plans has been polled;

automatically determining, by the computer, an amount of the transaction not covered by the benefit plans that is covered by the benefit savings accounts associated with the consumer based on sequentially sending a benefits savings account payment request to one or more payment sources associated with each of the benefit savings accounts, according to the ranking of the benefit savings accounts, until the computer has determined that either at least the predetermined amount of the transaction is covered by the benefit plans and the benefit savings accounts or until each of the benefit savings accounts has been polled;

automatically determining, by the computer, an amount of the transaction that is not covered by the benefit plans and the benefit savings accounts that is covered by a bank or credit account associated with the consumer based on sending a payment request to one or more payment sources associated with the bank or credit account, and determining, by the computer, that at least the predetermined amount of the transactions is covered by the benefit plans, benefits savings accounts, and the bank or credit account;

transmitting, by the computer to the POS device, information for display by the POS device, the information identifying the amount of the transaction that is covered by the benefit plans, the benefit savings accounts, and the bank or credit account, for the consumer;

receiving, by the computer from the POS device, an indication that the information has been conveyed to the consumer, and that the consumer has approved the transaction;

transferring, by the computer, based on the received approval indication, funds in the amounts that are covered by the benefit plans, the benefit savings accounts, and the bank or credit account from the payment sources associated with each of the benefit plans, benefit savings accounts, and the bank or credit account, respectively, to an account associated with the provider prior to undertaking the transaction; and

automatically transmitting, by the computer to the POS device, data authorizing the transaction when at least a portion of the predetermined amount of the transaction that is covered by the benefit plans, the benefit savings accounts, or the bank or credit account has been received in the account associated with the provider.

2. The method of claim 1, wherein the transmitted data authorizing the transaction identifies portions of the transaction not covered by the benefit plans.

3. The method of claim 1, further comprising:

verifying, by the computer, that the pre-authorization request identifies a category of the transaction, the provider, and the consumer.

4. The method of claim 1, further comprising:

associating, by the computer, a standard benefit plan reimbursement rate with the transaction; and

comparing, by the computer, the payment with the standard benefit plan reimbursement rate.

5. The method of claim 1, further comprising:

determining, by the computer, whether the consumer has claims against the benefit plans exceeding a predetermined payment threshold.

6. The method of claim 1, further comprising:

performing, by the computer, a risk assessment to determine whether the consumer is likely to pay for any portions of the transaction not covered by the benefit plans, wherein the risk assessment is based on information pertaining to the benefit plans and the benefit savings accounts.

7. The method of claim 1, further comprising determining, by the computer, whether to guarantee payment of the transaction based on at least one of the benefit plans and an ability of the consumer to pay for at least a portion of the transaction.

8. The method of claim 1, further comprising transmitting, by the computer, data including a claim for the transaction to a network node associated with at least one of the benefit plans.

9. The method of claim 1, further comprising:

assessing, by the computer, a fee against the provider for providing a service of transferring the funds in amounts to the provider; and

transferring, by the computer, the funds in the amounts, minus the assessed fee, to the provider.

10. The method of claim 1, further comprising:

assessing, by the computer, a fee against the consumer for providing a service of transferring the funds in the amounts to the provider; and

transferring, by the computer, the fee from an account associated with the consumer.

11. The method of claim 1, further comprising:

assessing, by the computer, a fee against the one or more payment sources associated with each of the benefit plans, the one or more payment sources associated with each of the benefits savings accounts, or the one or more payment sources associated with the bank or credit account, the fee being for providing a service of transferring the funds in the amounts to the account associated with the provider; and

transferring, by the computer, at least a portion of the fee from the one or more payment sources associated with each of the benefit plans, the one or more payment sources associated with each of the benefits savings accounts, or the one or more payment sources associated with the bank or credit account.

12. A benefit coordination utility system comprising:

a point of service (POS) device configured to send a pre-authorization request to assure payment for a predetermined amount of a transaction with a consumer prior to a provider undertaking the transaction, the transaction being associated with a provision of a healthcare service, a sale of a healthcare product, or a lease of a healthcare product;

one or more computers; and

a computer-readable storage medium coupled to the one or more computers having instructions stored thereon which, when the instructions are executed by the one or more computers, causes the one or more computers to perform operations comprising;

receiving, by the one or more computers and from the point of service (POS) device, the pre-authorization request,

automatically generating, by the one or more computers, prior to undertaking the transaction, a ranking of benefit plans and benefit savings accounts associated with the consumer, wherein automatically generating the ranking further comprises determining at least whether a primary member of a particular benefit plan is the consumer, a spouse of the consumer, or a partner of the consumer, whether a particular benefit plan is employer sponsored, and whether a particular benefit plan includes a primacy provision,

automatically determining, by the one or more computers, an amount of the transaction that is covered by the benefit plans associated with the consumer based on sequentially sending a benefit plan payment request to one or more payment sources associated with each of the benefit plans, according to the ranking of the benefit plans, until the one or more computers have determined that either at least the predetermined amount of the transaction is covered by the benefit plans or until each of the benefit plans has been polled,

automatically determining, by the one or more computers, an amount of the transaction not covered by the benefit plans that is covered by the benefit savings accounts associated with the consumer based on sequentially sending a benefits savings account payment request to one or more payment sources associated with each of the benefit savings accounts, according to the ranking of the benefit savings accounts, until the one or more computers have determined that either at least the predetermined amount of the transaction is covered by the benefit plans and the benefit savings accounts or until each of the benefit savings accounts has been polled,

automatically determining, by the one or more computers, an amount of the transaction that is not covered by the benefit plans and the benefit savings accounts that is covered by a bank or credit account associated with the consumer based on sending a payment request to one or more payment sources associated with the bank or credit account, and determining, by the one or more computers, that at least the predetermined amount of the transactions is covered by the benefit plans, benefits savings accounts, and the bank or credit account,

transmitting, by the one or more computers to the POS device, information for display by the POS device, the information identifying the amount of the transaction that is covered by the benefit plans, the benefit savings accounts, and the bank or credit account, for the consumer,

receiving, by the one or more computers from the POS device, an indication that the information has been conveyed to the consumer, and that the consumer has approved the transaction,

transferring, by the one or more computers, based on the received approval indication, funds in the amounts that are covered by the benefit plans, the benefit savings accounts, and the bank or credit account from the payment sources associated with each of the benefit plans, benefit savings accounts, and the bank or credit account, respectively, to an account associated with the provider prior to undertaking the transaction; and

automatically transmitting, by the one or more computers to the POS device, data authorizing the transaction when at least a portion of the predetermined amount of the transaction that is covered by the benefit plans, the benefit savings accounts, or the bank or credit account has been received in the account associated with the provider.

13. A computer-readable storage medium encoded with a computer program comprising instructions that, when the instructions are executed by a computer, operate to cause the computer to perform operations comprising:

receiving, by a computer and from a point of service (POS) device, a pre-authorization request to assure payment for a predetermined amount of a transaction with a consumer prior to a provider undertaking the transaction, the transaction being associated with a provision of a healthcare service, a sale of a healthcare product, or a lease of a healthcare product;

automatically generating, by the computer, prior to undertaking the transaction, a ranking of benefit plans and benefit savings accounts associated with the consumer, wherein automatically generating the ranking further comprises determining at least whether a primary member of a particular benefit plan is the consumer, a spouse of the consumer, or a partner of the consumer, whether a particular benefit plan is employer sponsored, and whether a particular benefit plan includes a primacy provision;

automatically determining, by the computer, an amount of the transaction that is covered by the benefit plans associated with the consumer based on sequentially sending a benefit plan payment request to one or more payment sources associated with each of the benefit plans, according to the ranking of the benefit plans, until the computer has determined that either at least the predetermined amount of the transaction is covered by the benefit plans or until each of the benefit plans has been polled;

automatically determining, by the computer, an amount of the transaction not covered by the benefit plans that is covered by the benefit savings accounts associated with the consumer based on sequentially sending a benefits savings account payment request to one or more payment sources associated with each of the benefit savings accounts, according to the ranking of the benefit savings accounts, until the computer has determined that either at least the predetermined amount of the transaction is covered by the benefit plans and the benefit savings accounts or until each of the benefit savings accounts has been polled;

automatically determining, by the computer, an amount of the transaction that is not covered by the benefit plans and the benefit savings accounts that is covered by a bank or credit account associated with the consumer based on sending a payment request to one or more payment sources associated with the bank or credit account, and determining, by the computer, that at least the predetermined amount of the transactions is covered by the benefit plans, benefits savings accounts, and the bank or credit account;

transmitting, by the computer to the POS device, information for display by the POS device, the information identifying the amount of the transaction that is covered by the benefit plans, the benefit savings accounts, and the bank or credit account, for the consumer;

receiving, by the computer from the POS device, an indication that the information has been conveyed to the consumer, and that the consumer has approved the transaction;

transferring, by the computer, based on the received approval indication, funds in the amounts that are covered by the benefit plans, the benefit savings accounts, and the bank or credit account from the payment sources associated with each of the benefit plans, benefit savings accounts, and the bank or credit account, respectively, to an account associated with the provider prior to undertaking the transaction; and

automatically transmitting, by the computer to the POS device, data authorizing the transaction when at least a portion of the predetermined amount of the transaction that is covered by the benefit plans, the benefit savings accounts, or the bank or credit account has been received in the account associated with the provider.