Centralized EOB archiving and access

• US 10,395,006 B2
• Filed: 03/06/2015
• Issued: 08/27/2019
• Est. Priority Date: 01/25/2007
• Status: Active Grant

• Current Assignee: Alegeus Technologies, LLC (Alegeus Technologies Holdings Corp.)
• Original Assignee: Alegeus Technologies, LLC (Alegeus Technologies Holdings Corp.)
• Inventors: Brown, Steven T.
• Primary Examiner(s): Borlinghaus, Jason
• Application Number:
  US14/640,293
• Publication Number:
  US 20150178454A1
• Time in Patent Office: 1,635 Days
• Field of Search: None
• CPC Class Codes: G06Q 10/087 Inventory or stock management, e.g. order filling, procurement or balancing against orders
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 40/08 Insurance
• CPC Class Codes: G16H 10/60 for patient-specific data, e.g. for electronic patient records
• CPC Class Codes: G16H 40/20 for the management or administration of healthcare resources or facilities, e.g. managing hospital staff or surgery rooms

Abstract

Methods and systems provide substantiation proof of claims made against medical spending accounts. Medical-insurance adjudication explanations are received at a benefits-records system, specifying a medical-insurance claim submitted to a medical insurer and identifying an adjudication decision of the medical insurance claim. The medical-insurance adjudication explanations are stored in a common format. A request is received from an insured party to apply a payment amount to a medical spending account. The payment amount corresponds to an expense associated with a medical-insurance claim submitted to one of the medical insurers but not paid. The request is posted to a third-party administrator with information from the corresponding medical-insurance adjudication explanations.

Claims

1. A system for managing electronic records of benefit information, comprising:

a communications interface of a benefits-records system configured to establish, via a computer network, a first secure network connection with a first device of a first insurance provider of a plurality of insurance providers;

the communications interface further configured to receive, via the first secure network connection from the first device of the first insurance provider, a first electronic record comprising, in a first format having a first plurality of fields, data from the plurality of fields indicating an insured employee and a first medical-insurance adjudication explanation for a first service of a first patient generated by the first insurance provider;

the communications interface further configured to establish, via the computer network, a second secure network connection with a second device of a second insurance provider of the plurality of insurance providers;

the communications interface further configured to receive, via the second secure network connection from the second device of the second insurance provider, a second electronic record comprising, in a second format having a second plurality of fields different from the first format, data from the plurality of fields indicating the insured employee and a second medical-insurance adjudication explanation for a second service of a second patient generated by the second insurance provider, the second patient different from the first patient;

the communications interface further configured to receive, via the computer network from a third device of the insured employee, a fourth electronic record comprising, in a third format, data indicating the insured employee and a third medical-insurance adjudication explanation for a third service generated by a device of a third insurance provider;

the communications interface further configured to transmit, via the computer network, the first electronic record, the second electronic record, and the fourth electronic record to one or more devices designated by request of insured party;

a processor of the benefits-records system configured to;

identify the first format of the first electronic record based on an identity of the first insurance provider;

extract, based on the provided information defining the first format of the first insurance provider, data from the first electronic record corresponding to the provided information;

provide, based on unidentified one or more portions of first format, an interface configured to receive user input for the first electronic record;

obtain an indication of an unpaid expense determined from adjudication of a medical-insurance claim adjudicated by the first insurance provider;

convert, using a mapping of data extracted from the first electronic record and the user input received from the interface, the first electronic record in the first format into a common format configured for the benefits-records system that is common to each of the plurality of insurance providers;

store the converted first electronic record in a storage device of the benefits-records system, the benefits-records system configured with a data repository that maintains electronic records in the common format;

identify the second format of the second electronic record based on an identity of the second insurance provider, the second format different from the first format;

convert, using the mapping of data extracted from the second electronic record and the user input received from the interface, the second electronic record in the second format into the common format;

convert, using the mapping of data extracted from the fourth electronic record and the user input received from the interface, the fourth electronic record in the third format into the common format;

generate, using the converted first electronic record, the converted second electronic record, and the converted fourth electronic record, a third electronic record for a single explanation of benefits comprising, in a single optically readable bar code that concatenates information from the first plurality of fields and the second plurality of fields with a descriptor of the optically readable bar code, data indicating (i) the first medical-insurance adjudication explanation for the first service of the first patient received, by the benefits-records system, in the first format via the first secure network connection with the first device of the first insurance provider, (ii) the second medical-insurance adjudication explanation for the second service of the second patient received, by the benefits-records system, in the second format via the second secure network connection with the second device of the second insurance provider, (iii) the third medical-insurance adjudication explanation, and (iv) the indication of the unpaid expense associated with one or more medical-insurance claims in the third electronic record for the single explanation of benefits; and

transmit, to a fourth device of the insured employee, the third electronic record for the single explanation of benefits in the single optically readable bar code with the descriptor, wherein the fourth device is configured to scan the single explanation of benefits and automatically extract, from the single optically readable bar code, data indicating (i) the first medical-insurance adjudication explanation for the first service of the first patient received, (ii) the second medical-insurance adjudication explanation for the second service of the second patient, (iii) the third medical-insurance adjudication explanation, and (iv) the indication of the unpaid expense associated with the one or more medical-insurance claims in the third electronic record for the single explanation of benefits.

2. The system of claim 1, wherein the processor is further configured to:

store, in the data repository of the storage device, the first electronic record in the common format; and

store, in the data repository of the storage device, the second electronic record in the common format.

3. The system of claim 1, wherein the processor is further configured to:

store, in the data repository of the storage device, the first electronic record in the common format;

store, in the data repository of the storage device, the second electronic record in the common format; and

retrieve, from the data repository of the storage device, responsive to the request, the stored first electronic record in the common format and the stored second electronic record in the common format to generate the third electronic record for the single explanation of benefits.

4. The system of claim 1, wherein the processor is further configured to:

convert at least a part of the first medical-insurance adjudication explanation into a first optically readable bar code; and

convert at least a part of the second medical-insurance adjudication explanation into a second optically readable bar code.

5. The system of claim 1, wherein:

the communications interface is further configured to receive, in a plurality of formats, a plurality of medical-insurance adjudication explanations comprising a specification of the medical-insurance claim submitted to the first insurance provider and identifying an adjudication decision of the medical-insurance claim, the plurality of formats including at least one of a portable document format, facsimile transmission, a scanned statement in an electronic format, or a textual format of a short-message-service; and

the processor is further configured to store, in the data repository, each of the plurality of medical-insurance adjudication explanations in the common format.

6. The system of claim 1, wherein one of the first format or the second format comprises an optically readable bar code.

7. The system of claim 1, wherein the processor is further configured to:

receive, from the third device of the insured employee, a request to apply a payment amount to a medical spending account corresponding to an expense associated with a medical-insurance claim in the third electronic record for the single explanation of benefits.

8. The system of claim 7, wherein the medical spending account comprises at least one of a flexible spending account, a health savings account, or a health reimbursement account.

9. The system of claim of claim 1, wherein:

the communications interface is configured to receive, via the computer network from the third device of the insured employee, the fourth electronic record comprising, in the third format, data indicating the insured employee and the third medical-insurance adjudication explanation for the third service generated by a device of the third insurance provider; and

the processor generates the third electronic record for the single explanation of benefits with data indicating the first medical-insurance adjudication explanation, the second medical-insurance adjudication explanation, and the third medical-insurance adjudication explanation.

10. A system for managing electronic records of benefit information, comprising:

a communications interface of a benefits-records system configured to receive, via a first secure network connection over a computer network from a first device of a first insurance provider, a first electronic record for a first patient, the first electronic record comprising, in a first format having a first plurality of fields, a first medical-insurance adjudication explanation for a first service and identifying an insured employee;

the communications interface of the benefits-records system further configured to receive, via a second secure network connection from a second device of a second insurance provider different from the first insurance provider, a second electronic record for a second patient different from the first patient, the second electronic record comprising, in a second format having a second plurality of fields different from the first format, a second medical-insurance adjudication explanation for a second service different from the first service and an identification of the insured employee;

the communications interface further configured to receive, via the computer network from a third device of the insured employee, a fourth electronic record comprising, in a third format, data indicating the insured employee and a third medical-insurance adjudication explanation for a third service generated by a device of a third insurance provider;

the communications interface further configured to transmit, via the computer network, the first electronic record, the second electronic record, and the fourth electronic record to one or more devices designated by request of insured party;

a processor of the benefits-records system configured to;

identify the first format of the first electronic record based on an identity of the first insurance provider;

extract, based on the provided information defining the first format of the first insurance provider, data from the first electronic record corresponding to the provided information;

provide, based on unidentified one or more portions of first format, an interface configured to receive user input for the first electronic record;

obtain an indication of an unpaid expense determined from adjudication of a medical-insurance claim adjudicated by the first insurance provider;

identify the second format of the second electronic record based on an identity of the second insurance provider, the second format different from the first format;

encode, based on a mapping of the first format to a common format and the second format to the common format, and the third format to the common format, for a third electronic record for a single explanation of benefits, a single optically readable bar code that concatenates information from the first plurality of fields and the second plurality of fields with a descriptor of the optically readable bar code, the single optically readable bar code comprising;

(i) the first medical-insurance adjudication explanation for the first service of the first patient received, by the benefits-records system, in the first format via the first secure network connection with the first device of the first insurance provider, (ii) the second medical-insurance adjudication explanation for the second service of the second patient received, by the benefits-records system, in the second format via the second secure network connection with the second device of the second insurance provider, (iii) the third medical-insurance adjudication explanation, and (iv) the indication of the unpaid expense associated with one or more medical-insurance claims in the third electronic record for the single explanation of benefits;

generate a single electronic explanation of benefits record for the insured employee comprising the encoded single optically readable bar code; and

transmit, to a fourth device of the insured employee, the single electronic explanation of benefits record in the encoded single optically readable bar code with the descriptor to cause the fourth device to scan the single explanation of benefits and automatically extract, from the encoded single optically readable bar code, the data indicating (i) the first medical-insurance adjudication explanation for the first service of the first patient received, (ii) the second medical-insurance adjudication explanation for the second service of the second patient, (iii) the third medical-insurance adjudication explanation, and (iv) the indication of the unpaid expense associated with the one or more medical-insurance claims in the third electronic record for the single explanation of benefits.

11. The system of claim 10, further comprising:

a storage device including a data repository that maintains electronic records in the common format,

wherein the processor is further configured to;

store, in the data repository of the storage device, the first electronic record in the common format; and

store, in the data repository of the storage device, the second electronic record in the common format.

12. The system of claim 10, further comprising:

a storage device including a data repository that maintains electronic records in the common format,

wherein the processor is further configured to;

store, in the data repository of the storage device, the first electronic record in the common format;

store, in the data repository of the storage device, the second electronic record in the common format; and

retrieve, from the data repository of the storage device, responsive to the request, the stored first electronic record in the common format and the stored second electronic record in the common format to generate the single electronic explanation of benefits record.

13. The system of claim 10, wherein the processor is further configured to:

convert at least a part of the first medical-insurance adjudication explanation into a first optically readable bar code; and

convert at least a part of the second medical-insurance adjudication explanation into a second optically readable bar code.

14. The system of claim 10, wherein:

the communications interface is further configured to receive, in a plurality of formats, a plurality of medical-insurance adjudication explanations comprising a specification of the medical-insurance claim submitted to the first insurance provider and identifying an adjudication decision of the medical-insurance claim, the plurality of formats including at least one of a portable document format, facsimile transmission, a scanned statement in an electronic format, or a textual format of a short-message-service; and

the processor is further configured to store, in a data repository of a storage device, each of the plurality of medical-insurance adjudication explanations in the common format.

15. The system of claim 10, wherein one of the first format or the second format comprises an optically readable bar code.

16. The system of claim 10, wherein the processor is further configured to:

receive, from the third device of the insured employee, a request to apply a payment amount to a medical spending account corresponding to an expense associated with a medical-insurance claim in the third electronic record for the single explanation of benefits.

17. The system of claim 16, wherein the medical spending account comprises at least one of a flexible spending account, a health savings account, or a health reimbursement account.

18. The system of claim 10, wherein:

the communications interface is further configured to receive, via the computer network from the third device of the insured employee, the fourth electronic record comprising, in the third format, data indicating the insured employee and the third medical-insurance adjudication explanation for the third service generated by the fourth device of the third insurance provider; and

the processor generates the third electronic record for the single explanation of benefits using data indicating the first medical-insurance adjudication explanation, the second medical-insurance adjudication explanation, and the third medical-insurance adjudication explanation.