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System and method for obtaining, maintaining and maximizing healthcare benefits

  • US 8,126,727 B2
  • Filed: 08/01/2007
  • Issued: 02/28/2012
  • Est. Priority Date: 08/01/2006
  • Status: Active Grant
First Claim
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1. A method for obtaining and maintaining patient health care benefits comprising the following steps:

  • a. receiving patient data in a computer, the patient data relating to a patient and including demographic data, health data and financial data;

    b. based upon the patient data, applying health care benefits program coverage criteria for one or more health care benefits programs to the patient data within the computer, wherein the health care benefits program coverage criteria include enrollment eligibility conditions for each health care benefit program;

    c. within the computer, identifying;

    (1) any health care benefits programs wherein the patient meets all of the health care benefits program coverage criteria for each of the health care benefits programs, thereby identifying the health care benefits programs for which the patient is currently eligible for enrollment;

    (2) any health care benefits programs wherein the patient does not meet all of the health care benefits program coverage criteria for the health care benefits programs, but meets over at least 70% of the health care benefits program coverage criteria for the health care benefits programs, thereby identifying the health care benefits programs for which the patient is almost eligible for enrollment;

    d. for any identified health care benefits programs for which the patient is currently eligible for enrollment;

    (1) providing a benefits program enrollment application;

    (2) submitting the benefits program enrollment application;

    (3) receiving benefits program enrollment verification;

    e. for any identified health care benefits programs for which the patient is almost eligible for enrollment, identifying the health care benefits program coverage criteria that must be met by the patient to attain eligibility for enrollment;

    f. obtaining updated patient data;

    g. after obtaining updated patient data, dynamically providing a report identifying;

    (1) any health care benefits programs for which the patient is currently eligible for enrollment, and(2) any health care benefits programs for which the patient is almost eligible for enrollment, and the health care benefits program coverage criteria that must be met by the patient to attain eligibility for enrollment;

    h. providing a change event status notification, the notification identifying an actual or potential change event that alters benefits coverage based upon the patient data and health care benefits program coverage criteria.

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