Healthcare eligibility transactions

• US 7,822,624 B2
• Filed: 07/26/2006
• Issued: 10/26/2010
• Est. Priority Date: 07/26/2006
• Status: Active Grant

• Current Assignee: Alegeus Technologies, LLC (Alegeus Technologies Holdings Corp.)
• Original Assignee: Metavante Corporation (Fidelity National Information Services Incorporated)
• Inventors: Widenski, Henry Anthony Jr., Brown, Steven T., Gruchalski, Joanne E., Erdmann, Jeffrey Jay, Lindsey, Jimmie, Perry, Daniel L., Butkowski, Rosanne Marie, Norman, Douglas Luther, Neuville, Mark Andrew, Leininger, Greg
• Primary Examiner(s): O'Connor; Gerald J.
• Assistant Examiner(s): LE, LINH GIANG
• Application Number:
  US11/460,208
• Publication Number:
  US 20080027863A1
• Time in Patent Office: 1,553 Days
• Field of Search: 235/375, 235/380, 235/383, 340/572.1, 705/22, 705/24, 705/26, 705 2- 4
• US Class Current: 705/2
• CPC Class Codes: G06Q 20/203 Inventory monitoring
• CPC Class Codes: G06Q 20/209 Specified transaction journal output feature, e.g. printed receipt or voice output
• 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 30/06 Buying, selling or leasing transactions
• CPC Class Codes: G06Q 30/0633 Lists, e.g. purchase orders, compilation or processing
• CPC Class Codes: G06Q 40/08 Insurance

Abstract

Methods and systems permit registration of a service provider and permit eligibility information to be provided to the service provider. Registration information is received over a financial network from a point-of-sale terminal. The registration information has an identifier associated with the point-of-sale terminal and an identification of the service provider. The identifier is associated with information identifying a device disposed at a location of the service provider in a database, permitting a communication path to the device to be established. A confirmation of registration of the point-of-sale terminal is transmitted to the device over the communication path.

Claims

1. A method of providing eligibility information to a healthcare service provider and registering a point-of-sale terminal of the healthcare service provider, the method comprising:

receiving, at a host computer system, healthcare service provider program participation registration information over a financial network from the point-of-sale terminal, the healthcare service provider program participation registration information including a first identifier identifying the point-of-sale terminal and an identification of the healthcare service provider;

determining, by the host computer system using the first identifier, that the healthcare service provider is eligible to be a participant in a healthcare service provider program by performing a lookup to determine if the healthcare service provider has previously registered with the host computer system using healthcare service provider program participation registration materials, wherein the healthcare service provider program includes providing subscriber eligibility information to the healthcare service provider regarding a subscriber'"'"'s eligibility to receive healthcare services from the healthcare service provider;

creating, by the host computer system, a healthcare service provider record including the healthcare service provider program participation registration information, wherein the healthcare service provider record is utilized in identifying the healthcare service provider during subsequent requests to provide subscriber eligibility information to the healthcare service provider;

determining, by the host computer system, a confirmation of healthcare service provider program participation registration;

linking, by the host computer system, the first identifier with information identifying a device disposed at a location of the healthcare service provider in a database, wherein the device is different from the point-of-sale terminal;

establishing a communication path to the device with the information identifying the device; and

transmitting the confirmation of healthcare service provider program participation registration of the point-of-sale terminal to the device over the communication path before receiving a subscriber eligibility authorization request to determine if the subscriber is eligible to receive healthcare services from the healthcare service provider.

2. The method recited in claim 1 wherein the financial network comprises an ATM network.

3. The method recited in claim 1 wherein a portion of the healthcare service provider program participation registration information that includes the identification of the healthcare service provider was extracted from a registration instrument read by the point-of-sale terminal.

4. The method recited in claim 3 wherein the registration instrument comprises a magnetic-stripe card.

5. The method recited in claim 1 further comprising establishing a web site for managing eligibility information for the healthcare service provider with secure access by the healthcare service provider using the healthcare service provider program participation registration information.

6. The method recited in claim 1 wherein the device comprises a fax machine and the communication path includes the public-telephone switch network.

7. The method recited in claim 1 wherein the device comprises a computational device and the communication path includes the Internet.

8. The method recited in claim 1 further comprising:

receiving the subscriber eligibility authorization request over the financial network from the point-of-sale terminal, the subscriber eligibility authorization request including the first identifier and a second identifier identifying a subscriber;

retrieving the subscriber eligibility information from a data store using the second identifier, wherein the subscriber eligibility information indicates eligibility of the subscriber to receive a healthcare service from the healthcare service provider in accordance with a policy of a third party different from the service provider and different from the subscriber; and

transmitting the subscriber eligibility information to the healthcare service provider.

9. The method recited in claim 8 wherein transmitting the subscriber eligibility information to the healthcare service provider comprises transmitting a response to the subscriber eligibility authorization request over the financial network to the point-of-sale terminal.

10. The method recited in claim 9 wherein:

the subscriber eligibility authorization request further includes a nominal transaction amount; and

the response comprises a decline code that indicates an approval of the subscriber eligibility authorization request.

11. The method recited in claim 9 wherein:

the subscriber eligibility authorization request further includes a zero transaction amount; and

the response comprises an approval code that indicates an approval of the subscriber eligibility authorization request.

12. The method recited in claim 8 wherein transmitting the subscriber eligibility information to the healthcare service provider comprises:

retrieving the information identifying the device from the database;

establishing a second communication path to the device with the information identifying the device; and

transmitting the subscriber eligibility information over the second communication path to the device.

13. The method recited in claim 8 wherein the service provider is a healthcare provider and the third party is an insurer.

14. The method recited in claim 8 wherein the second identifier comprises an identifier extracted from a presentation instrument issued to the subscriber.

15. The method recited in claim 14 wherein the presentation instrument comprises a magnetic-stripe card.

27. The method of claim 13 further comprising identifying the insurer utilizing a bank identification number.

16. A method of providing subscriber eligibility information to a healthcare provider and registering a point-of-sale terminal of the healthcare provider, the subscriber eligibility information indicating eligibility of a subscriber to receive a service from the healthcare provider in accordance with a policy of an insurer, the method comprising:

receiving, at a host computer system, healthcare provider program participation registration information over an ATM network from the point-of-sale terminal, the healthcare provider program participation registration information including a first identifier identifying the point-of-sale terminal and an identification of the healthcare provider, wherein the healthcare provider program participation registration information was extracted from a magnetic-stripe registration card read by the point-of-sale terminal;

determining, by the host computer system using the first identifier, that the healthcare provider is eligible to be a participant in a healthcare provider program by performing a lookup to determine if the healthcare provider has previously registered with the host computer system using healthcare provider program participation registration materials, wherein the healthcare provider program includes providing subscriber eligibility information to the healthcare provider regarding a subscriber'"'"'s eligibility to receive healthcare services from the healthcare provider;

determining, by the host computer system, a confirmation of healthcare provider program participation registration;

linking the first identifier with information identifying a fax machine or computer disposed at a location of the healthcare provider in a database;

establishing a communication path to the fax machine or computer with the information identifying the fax machine or computer;

transmitting the confirmation of healthcare provider program participation registration of the point-of-sale terminal to the fax machine or computer over the communication path before receiving a subscriber eligibility authorization request;

receiving the subscriber eligibility authorization request over the ATM network from the point-of-sale terminal, the subscriber eligibility authorization request including the first identifier, a second identifier identifying the subscriber, and a nominal transaction amount, wherein the second identifier comprises an identifier extracted from a magnetic-stripe card issued to the subscriber;

retrieving the subscriber eligibility information from a data store using the second identifier;

retrieving the information identifying the fax machine or computer from the database;

establishing a second communication path to the fax machine or computer with the information identifying the fax machine or computer;

transmitting the subscriber eligibility information over the second communication path to the fax machine or computer; and

transmitting a response to the subscriber eligibility authorization request over the ATM network to the point-of-sale terminal.

17. A system for providing subscriber eligibility information to a healthcare provider and registering a point-of-sale terminal of the healthcare provider, the system comprising:

a communications device coupled with an ATM network;

a processor;

a storage device;

a memory coupled with the processor, the memory comprising a computer-readable medium having a computer-readable program embodied therein for directing operation of the system, the computer-readable program including;

instructions for receiving healthcare provider program participation registration information with the communications device over the ATM network from the point-of-sale terminal, the healthcare provider program participation registration information including a first identifier identifying the point-of-sale terminal and an identification of the healthcare provider;

instructions for determining that the healthcare provider is eligible to be a participant in a healthcare provider program by performing a lookup to determine if the healthcare provider has previously registered with the host computer system using healthcare provider program participation registration materials, wherein the healthcare provider program includes providing subscriber eligibility information to the healthcare provider regarding a subscriber'"'"'s eligibility to receive healthcare services from the healthcare provider;

instructions for determining a confirmation of healthcare provider program participation registration;

instructions for linking the first identifier with information identifying a fax machine or computer disposed at a location of the healthcare provider on the storage device;

instructions for establishing a communication path from the communications device to the fax machine or computer with the information identifying the fax machine or computer;

instructions for transmitting the confirmation of healthcare provider program participation registration of the point-of-sale terminal to the fax machine or computer over the communication path with the communications device.

18. The system recited in claim 17 wherein a portion of the healthcare provider program participation registration information that includes the identification of the healthcare provider was extracted from a registration instrument read by the point-of-sale terminal.

19. The system recited in claim 18 wherein the registration instrument comprises a magnetic-stripe card.

20. The system recited in claim 17 wherein the computer-readable program further includes instructions establishing a web site for managing eligibility information for the healthcare provider with secure access by the healthcare provider using the healthcare provider program participation registration information.

21. The system recited in claim 17 wherein the computer-readable program further includes:

instructions for receiving an subscriber eligibility authorization request with the communications device over the ATM network from the point-of-sale terminal, the subscriber eligibility authorization request including the first identifier and a second identifier identifying a subscriber;

instructions for retrieving subscriber eligibility information from the storage device using the second identifier, wherein the subscriber eligibility information indicates eligibility of the subscriber to receive a service from the healthcare provider in accordance with a policy of an insurer; and

instructions for transmitting the subscriber eligibility information to the healthcare provider with the communications device.

22. The system recited in claim 21 wherein the instructions for transmitting the subscriber eligibility information to the healthcare provider comprise instructions for transmitting a response to the subscriber eligibility authorization request over the ATM network to the point-of-sale terminal.

23. The system recited in claim 22 wherein:

the subscriber eligibility authorization request further includes a nominal transaction amount; and

the response comprises a decline code that indicates a refusal of the subscriber eligibility authorization request.

24. The system recited in claim 22 wherein:

the subscriber eligibility authorization request further includes a zero transaction amount; and

the response comprises an approval code that indicates an approval of the subscriber eligibility authorization request.

25. The system recited in claim 21 wherein the instructions for transmitting the subscriber eligibility information to the healthcare provider comprise:

instructions for retrieving the information identifying the fax machine or computer from the storage device;

instructions for establishing a second communication path from the communications device to the fax machine or computer with the information identifying the fax machine or computer; and

instructions for transmitting the subscriber eligibility information over the second communication path to the fax machine or computer with the communications device.

26. The system recited in claim 21 wherein the second identifier comprises an identifier extracted from a presentation instrument issued to the subscriber.