Medical benefit management system and method

A system for configuration, management and payment of medical benefits related to a plurality of medical merchants, the system enabling rule customization in real-time using a plurality of configuration files for encoding business logic without impacting continued operation of benefit processing, the system comprising:

• a provider server system;
• a merchant server system;
• and
• a medical benefit management system comprising
• a connection manager for receiving the plurality of configuration files for encoding business logic,
• a stream processor for managing communications with the provider server system and the merchant server system,
• a portal server, and
• one or more data storage devices comprising a plurality of computer-readable instructions,
• wherein the instructions comprise a plurality of benefit business rules, wherein the instructions are executable by one or more processors to cause the one or more processors to:
• receive using the connection manager a first configuration file from the provider server system comprising offering data from a provider, wherein the offering data specifies at least one medical benefit offering that is associated with a product marketed by the provider;
• receive using the connection manager a second configuration file from the provider server system comprising at least one rule customization input from the provider;
• customize, in real-time without impacting continued operation of the system, at least one of the benefit business rules based, at least in part, on the at least one rule customization input, wherein the at least one rule customization input comprises processing logic to determine a primary payer, a secondary payer and a tertiary payer of an insurance benefit, wherein the system concurrently operate to receive and process benefit submissions during the customizing;
• receive using the connection manager a third file from the merchant server system comprising a benefit submission from a medical merchant, wherein the benefit submission is based, at least in part, on a medical request received by the medical merchant, wherein the medical request is provided by a customer;
• process the benefit submission using the at least one customized business rule, wherein the processing comprises executing the processing logic based on the received benefit submission to determine payment by the primary payer, the secondary payer and the tertiary payer;
• generate benefit transaction information related to the benefit submission, wherein the benefit transaction information comprises a first portion and a second portion that differs from the first portion;
• and
• cause a plurality of display devices to simultaneously display a provider interface accessible by the provider using the portal server and a merchant interface accessible by the medical merchant using the portal server, wherein:
• the provider interface displays the first portion and blocks access to the second portion;
• and
• the merchant interface displays the second portion and blocks access to the first portion, such that the portal server displays different views of the benefit transaction information to the provider and the medical merchant;
• and
• generate a benefit outcome based on the processing of the benefit submission, wherein the benefit outcome results in the at least one medical benefit being provided by the medical merchant to the customer.