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Systems and methods for the identification of available payers for healthcare transactions

  • US 8,335,672 B1
  • Filed: 03/26/2010
  • Issued: 12/18/2012
  • Est. Priority Date: 03/26/2010
  • Status: Active Grant
First Claim
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1. A method, comprising:

  • receiving, by a service provider system comprising one or more computers, a reply to a healthcare claim transaction from a claims processor computer;

    determining, by the service provider system based at least in part on an evaluation of the reply, that the healthcare claim transaction has been rejected for an eligibility reason indicating either that a patient associated with the healthcare claim transaction is not covered for benefits or that incorrect coverage information was included in the healthcare claim transaction;

    generating an eligibility request for the patient;

    communicating the eligibility request to an eligibility system;

    identifying, by the service provider system based at least in part on the determination that the healthcare claim transaction was rejected for an eligibility reason and a response to the eligibility request, an available payer for the patient; and

    communicating, by the service provider system, information associated with the identified available payer to a healthcare provider associated with the healthcare claim transaction.

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