Centralized eob archiving and access

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...

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 initiate requests for application of amounts not covered by insurance to medical spending accounts. At the same time, the standard format of the records permits efficient transmittal of such requests to third-party administrators with substantiation documentation that meets reporting requirements.

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, it also creates an environment in which management of relevant information may be difficult.

This reporting is further complicated by the different reporting formats used by the insurers.

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