Method and system for processing transactions involving accounts for reimbursing medical expenses or patient responsible balances with multiple transaction substantiation modes

• US 7,197,468 B1
• Filed: 12/19/2003
• Issued: 03/27/2007
• Est. Priority Date: 06/11/2001
• Status: Expired due to Term

• Current Assignee: WEX Health, Inc. (WEX Inc.)
• Original Assignee: Evolution Benefits Incorporated (WEX Inc.)
• Inventors: Dallahan, Matthew J., Patricelli, Robert E., Rausch, Kent F.
• Primary Examiner(s): Thomas; Joseph
• Assistant Examiner(s): Najarian; Lena
• Application Number:
  US10/739,218
• Time in Patent Office: 1,194 Days
• Field of Search: 705/4
• US Class Current: 705/4
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 20/10 specially adapted for electronic funds transfer [EFT] systems; specially adapted for home banking systems
• CPC Class Codes: G06Q 20/102 Bill distribution or payments
• CPC Class Codes: G06Q 20/14 specially adapted for billing systems
• CPC Class Codes: G06Q 20/227 characterised in that multiple accounts are available, e.g. to the payer
• CPC Class Codes: G06Q 20/342 Cards defining paid or billed services or quantities
• 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 30/04 Billing or invoicing
• CPC Class Codes: G06Q 40/08 Insurance
• CPC Class Codes: G07F 17/0092 for assembling and dispensing of pharmaceutical articles medical dispensers for private use, A61J7/00
• CPC Class Codes: G07F 7/025 by means, e.g. cards, providing billing information at the time of purchase, e.g. identification of seller or purchaser, quantity of goods delivered or to be delivered
• CPC Class Codes: G16H 10/60 for patient-specific data, e.g. for electronic patient records

Abstract

The present invention relates to a method and system for processing transactions involving accounts for reimbursing medical expenses or patient responsible balances, wherein the accounts may be handled by multiple payors having multiple transaction substantiation requirements. Examples of such accounts include flexible spending accounts, health reimbursement arrangement accounts, medical savings account, health savings account and the like. The system and method of the present invention allow an employer that uses multiple payors for administering the aforementioned accounts to distinguish its employees-based on their associated payors in order to determine the proper transaction substantiation requirement per each employee and associated payor without having required to collect payor data at the employee level.

Claims

1. A computer implemented method for processing a transaction involving an account for reimbursing qualified medical expenses or patient responsible balances (PRBs), comprising the steps of:

receiving enrollment data of participants electing to perform payment-card transactions using account for reimbursing qualified medical expenses or PRBs;

receiving from a goods or service provider a request to authorize payment of a PRB against an account associated with a participant in connection with a first sales transaction between the participant and the goods or service provider;

assigning a status to the participant from one of a first and second statuses;

in response to the participant'"'"'s assigned status being of the first status, electronically performing a real-time substantiation of the first sales transaction using a computerized system, authorizing payment of the PRB against the associated account, communicating to the goods or service provider authorization of payment of the PRB against the associated account and effecting the payment of the PRB against the associated account, wherein the communicating the authorization and effecting the payment occur subsequently to the real-time substantiation and authorization; and

in response to the participant'"'"'s assigned status being of the second status, communicating to the goods or service provider authorization of payment of the PRB against the associated account, effecting the payment of the PRB against the associated account, and electronically performing a retrospective substantiation of the first sales transaction using a computerized system, where in the retrospective substantiation is performed subsequently to the communication of the authorization.

2. The computer-implemented method of claim 1, wherein the step of assigning the status to the participant comprises:

assigning the first status to the participant upon an expiration of a predetermined initial time period and a receipt of an assignment of the real-time substantiation to be performed with the participant.

3. The computer implemented method of claim 1, wherein the step of assigning the status to the participant comprises:

assigning the first status to the participant upon an expiration of a predetermined initial time period and a receipt of transaction data associated with the participant'"'"'s one or more sales transactions.

4. The computer implemented method of claim 1, wherein the step of assigning the status to the participant comprises:

assigning the second status to the participant upon a receipt of an assignment of the retrospective substantiation to be performed with the participant.

5. The computer implemented method of claim 1, wherein the step of assigning the status to the participant comprises:

assigning the second status to the participant when the participant is within a predetermined initial time period.

6. The computer implemented method of claim 1, wherein the step of assigning the status to the participant comprises:

assigning the second status to the participant upon an expiration of a predetermined initial time period and there is no receipt of transaction data associated with the participant'"'"'s one or more sales transactions.

7. The computer implemented method of claim 1, wherein the step of communicating to the goods or service provider comprises:

communicating to the goods or service provider authorization of payment of the PRB against the associated account subsequent to performing the real-time substantiation.

8. The computer implemented method of claim 1, wherein the step of performing the real-time substantiation comprises:

receiving transaction data associated with the participant'"'"'s one or more sales transactions;

comprising the transaction data with the first sales transaction to find a match of one or more pieces of the transaction data with the first sales transaction; and

in response to the matching, removing the matched one or more transaction data pieces from the transaction data for future comparisons.

9. The computer implemented method of claim 1, wherein the step of communicating to the goods or service provider comprises:

communicating to the goods or service provider authorization of payment of the PRB against the associated account prior to performing the retrospective substantiation.

10. The computer implemented method of claim 9, wherein the step of performing the retrospective substantiation comprises:

receiving transaction data associated with the participant'"'"'s one or more sales transactions;

comprising the transaction data with the first sales transaction to find a match of one or more pieces of the transaction data with the first sales transaction; and

in response to the matching, removing the matched one or more transaction data pieces from the transaction data for future comparisons.

11. The computer implemented method of claim 10, wherein the participant'"'"'s one or more sales transactions have been serviced a predetermined period of time prior to a date of receiving from the goods or service provider the request to authorize payment of the PRB.

12. The computer implemented method of claim 1, wherein the step of performing the retrospective substantiation comprises:

receiving transaction data associated with the participant'"'"'s one or more sales transactions;

comprising the transaction data with the first sales transaction to find a match of one or more pieces of the transaction data with the first sales transaction; and

in response to no matching of any of the transaction data pieces with the first sales transaction, requesting additional information from the participant regarding the first sales transaction.

13. The computer implemented method of claim 1, further comprising:

receiving a list of payors servicing the accounts, each payor subjected to an associated one of the real-time and retrospective substantiations.

14. The computer implemented method of claim 13, further comprising:

issuing to the participants payment cards linked to the accounts based on the enrollment data; and

receiving notices of activation of the issued payment cards from the participants.

15. The computer implemented method of claim 14, further comprising:

creating eligibility reports of the participants based on the received notices of activation; and

providing the eligibility reports to all the payors in the payors list.

16. The computer implemented method of claim 13, further comprising:

creating eligibility reports of the participants; and

providing the eligibility reports to all the payors in the payors list.

17. The computer implemented method of claim 10, wherein the step of receiving transaction data associated with the participant'"'"'s one or more sales transactions comprises:

receiving a list of payors servicing the accounts;

creating eligibility reports of the participants;

providing the eligibility reports to all the payors in the payors list;

one of the payors receiving claim information for the one or more sales transactions from one or more goods or service providers;

the received payor comparing the provided eligibility reports with the received claim information for a match; and

in response to the match of at least one of the provided eligibility reports with the claim information, the received payor providing the received transaction data associated with the participant'"'"'s one or more sales transactions.

18. The computer implemented method of claim 14, wherein the request to authorize payment is based on the associated participant using one of the issued payment cards at the goods or service provider.

38. The computer implemented method of claim 1, wherein the first and second substantiations are independent from each other.

19. A computer implemented method for processing transactions involving accounts for reimbursing qualified medical expenses or patient responsible balances (PRBs), comprising:

receiving enrollment data of participants electing to perform payment-card transactions using accounts for reimbursing qualified medical expenses or PRBs;

receiving from a first goods or service provider a request to authorize payment of a PRB against an account associated with a first participant in connection with a first sales transaction between the first participant and the first goods or service provider;

receiving from a second goods or service provider a request to authorize payment of a PRB against an account associated with a second participant in connection with a second sales transaction between the second participant and the second goods or service provider;

assigning a first status to the first participant;

assigning a second status to the second participant different from the first status;

in response to the participant'"'"'s assigned status being of the first status, electronically performing a real-time substantiation of the first sales transaction using a computerized system, providing authorization of payment of the PRB against the associated account, communicating to the goods or service provider authorization of payment of the PRB against the associated account and effecting the payment of the PRB against the associated account, wherein the communicating the authorization and effecting the payment occur subsequently to the real-time substantiation and authorization; and

in response to the second participant'"'"'s assigned second status, electronically performing a second substantiation of the second sales transaction using a computerized system, the second substantiation being a retrospective substantiation of the second sales transaction, communicating to the second goods or service provider authorization of payment of the PRB against the account associated with the second participant, effecting the payment of the PRB against the account associated with the second participant wherein the retrospective substantiation is performed subsequently to the communication of the authorization.

20. The computer implemented method of claim 19, wherein the step of assigning the first status to the first participant comprises:

assigning the first status to the first participant upon an expiration of a predetermined initial time period and a receipt of an assignment of the first substantiation to be performed with the first participant.

21. The computer implemented method of claim 19, wherein the step of assigning the first status to the first participant comprises:

assigning the first status to the first participant upon an expiration of a predetermined initial time period and a receipt of transaction data associated with the first participant'"'"'s one or more sales transactions.

22. The computer implemented method of claim 19, wherein the step of assigning the second status to the second participant comprises:

assigning the second status to the participant upon a receipt of an assignment of the second substantiation to be performed with the second participant.

23. The computer implemented method of claim 19, wherein the step of assigning the second status to the second participant comprises:

assigning the second status to the second participant when the second participant is within a predetermined initial time period.

24. The computer implemented method of claim 19, wherein the step of assigning the second status to the second participant comprises:

assigning the second status to the second participant upon an expiration of a predetermined initial time period and there is no receipt of transaction data associated with the second participant'"'"'s one or more sales transactions.

25. The computer implemented method of claim 19, wherein:

the step of communicating to the first goods or service provider comprises communicating to the first goods or service provider authorization of payment of the PRB against the account associated with the first participant subsequent to performing the first substantiation; and

the step of communicating to the second goods or service provider comprises communicating to the second goods or service provider authorization of payment of the PRB against the account associated with the second participant prior to performing the second substantiation.

26. The computer implemented method of claim 20, wherein the step of performing the first substantiation comprises:

receiving transaction data associated with the first participant'"'"'s one or more sales transactions;

comparing the transaction data with the first sales transaction to find a match of one or more pieces of the transaction data with the first sales transaction; and

in response to the matching, removing the matched one or more transaction data pieces from the transaction data for future comparisons.

27. The computer implemented method of claim 20, wherein the step of performing the second substantiation comprises:

receiving transaction data associated with the second participant'"'"'s one or more sales transactions;

comparing the transaction data with the second sales transaction to find a match of one or more pieces of the transaction data with the second sales transaction; and

in response to the matching, removing the matched one or more transaction data pieces from the transaction data for future comparisons.

28. The computer implemented method of claim 27, wherein the second participant'"'"'s one or more sales transactions have been serviced a predetermined period of time prior to a date of receiving from the second goods or service provider the second request to authorize payment of the PRB.

29. The computer implemented method of claim 20, wherein the step of performing the second substantiation comprises:

receiving transaction data associated with the participant'"'"'s one or more sales transactions;

comparing the transaction data with the second sales transaction to find a match of one or more pieces of the transaction data with the second sales transactions;

in response to no matching of any of the transaction data pieces with the second sales transaction, requesting additional information from the second participant regarding the second sales transaction.

30. The computer implemented method of claim 19, further comprising:

receiving a list of payors servicing the accounts, each payor subjected to an associated one of the first and second substantiations.

31. The computer implemented method of claim 30, further comprising:

issuing to the participants payment cards linked to the accounts based on the enrollment data; and

receiving notices of activation of the issued payment cards from the participants.

32. The computer implemented method of claim 31, further comprising:

creating eligibility reports of the participants based on the received notices of activation; and

providing the eligibility reports to all the payors in the list.

33. The computer implemented method of claim 21, further comprising:

creating eligibility reports of the participants;

providing the eligibility reports to all payors in the payors list.

34. The computer implemented method of claim 22, wherein the request to authorize payment is based on one of the participants using one of the issued payment cards at the goods or service provider.

35. The computer implemented method of claim 19, wherein the first goods or service provider and the second goods or service provider are the same.

36. The computer implemented method of claim 19, wherein the first goods or service provider and the second goods or service provider are different.

37. The computer implemented method of claim 19, wherein the participants are members of a single organization.