CENTRALIZED EOB ARCHIVING AND ACCESS

• US 20150178454A1
• Filed: 03/06/2015
• Published: 06/25/2015
• 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.
• Granted Patent: US 10,395,006 B2
• Time in Patent Office: Days
• US Class Current: 1/1
• 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;

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, data indicating an insured party 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;

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 different from the first format, data indicating the insured party 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;

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;

convert, using a mapping, the first electronic record in the first format into a common format for storing in a storage device of 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, the second electronic record in the second format into the common format;

generate, using the converted first electronic record and the converted second electronic record, a third electronic record for a single explanation of benefits comprising, in the common format, data indicating the first medical-insurance adjudication explanation for the first service and the second medical-insurance adjudication explanation for the second service; and

transmit, via a third secure network connection established with a third device of the insured party, responsive to a request from the third device of the insured party, 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 communication interface is further configured to receive, in a plurality of formats, a plurality of medical-insurance adjudication explanations comprising a specification of a 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:

provide an indication of an unpaid expense associated with a medical-insurance claim in the third electronic record for the single explanation of benefits.

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

receive, from the third device of the insured party, 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.

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

10. 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 party, a fourth electronic record comprising, in a third format, data indicating the insured party and a third medical-insurance adjudication explanation for a third service generated by a device of a third insurance provider; and

the processor is further configured to generate the third electronic record for the single explanation of benefits comprising data indicating the first medical-insurance adjudication explanation, the second medical-insurance adjudication explanation, and the third medical-insurance adjudication explanation.

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

a communications interface of a benefits-records system configured to receive, via 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 a first medical-insurance adjudication explanation for a first service and identifying an insured party;

the communications interface of the benefits-records system further configured to receive, via the computer network 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 a second medical-insurance adjudication explanation for a second service different from the first service and an identification of the insured party;

a processor of the benefits-records system configured to;

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

identify a 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, a single optically readable bar code comprising the first medical-insurance adjudication explanation for the first service and second medical-insurance adjudication explanation for the second service;

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

transmit, via the computer network responsive to a request from a third device of the insured party, the single explanation of benefits record in the common format for display via an interface.

12. The system of claim 11, 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.

13. The system of claim 11, 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.

14. The system of claim 11, 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.

15. The system of claim 11, wherein:

the communication interface is further configured to receive, in a plurality of formats, a plurality of medical-insurance adjudication explanations comprising a specification of a 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.

16. The system of claim 11, wherein one of the first format or the second format comprises an optically readable bar code.

17. The system of claim 11, wherein the processor is further configured to:

provide an indication of an unpaid expense associated with a medical-insurance claim in the third electronic record for the single explanation of benefits.

18. The system of claim 11, wherein the processor is further configured to:

receive, from the third device of the insured party, 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.

19. The system of claim 18, wherein the medical spending account comprises at least one of a flexible spending account, a health savings account, or a health reimbursement account.

20. The system of claim of claim 11, wherein:

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

the processor is further configured to generate the third electronic record for the single explanation of benefits comprising data indicating the first medical-insurance adjudication explanation, the second medical-insurance adjudication explanation, and the third medical-insurance adjudication explanation.