Centralized eob archiving and access

Inactive Publication Date: 2008-07-31
ALEGEUS TECH LLC
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  • Summary
  • Abstract
  • Description
  • Claims
  • Application Information

AI Technical Summary

Benefits of technology

[0008]Embodiments of the invention provide a central repository that maintains adjudication records of medical insurance claims in a standard format. This repository may act as a conduit for efficiently coordinating requests by insured parties to have access to the adjudication records and to in

Problems solved by technology

While this versatility makes for a flexible environment in which different types of medical spending accounts and different insurers may be used to accommodate individual circumstances,

Method used

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  • Centralized eob archiving and access
  • Centralized eob archiving and access
  • Centralized eob archiving and access

Examples

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Effect test

Example

[0020]Embodiments of the invention provide methods and systems for generating and storing benefits-determination information that may be provided by a variety of different insurers. Such benefits-determination information is generally provided by an insurer in the form of an “Explanation of Benefits” (“EOB”) statement that is transmitted in response to a request for payment and a decision by the insurer on the request. In different instances, the determination made by the insurer is prompted by receipt of a claim from an insured party or by receipt of a claim from a medical-services provider. When a claim is submitted by an insured party, it is usually submitted because the insured party has received and paid for medical services and therefore takes the form of a reimbursement request. When a claim is submitted by a medical-services provider, it is usually submitted because the provider has provided services to an insured party that have not been paid for and therefore takes the for...

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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.

Description

BACKGROUND OF THE INVENTION[0001]This application relates generally to medical spending accounts. More specifically, this application relates to the use of centralized repositories in managing insurance information used to support reporting requirements associated with medical spending accounts.[0002]There are currently a variety of different types of medical spending accounts. These different accounts are managed in different ways and are generally used for different purposes, but have as a common factor that they permit funds earned through employment to be applied on with certain income-tax advantages to pay for certain medical expenses. “Medical” expenses include expenses that arise in the diagnosis or treatment of conditions in the human body, including teeth or other oral structures in the form of dental expenses and including the eye and other ophthalmic structures in the form of vision expenses. Medical expenses may include fees to be paid to physicians, dentists, optometris...

Claims

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Application Information

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IPC IPC(8): G06Q40/00G06F19/00G16H10/60
CPCG06F19/328G06Q10/087G06Q50/24G06Q50/22G06Q40/08G16H10/60G06Q10/10G16H40/20
Inventor BROWN, STEVEN T.
Owner ALEGEUS TECH LLC
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