System and method for enhancing and authenticating an insurance elgibility transaction

A computer readable medium for execution on a computer processor, for authenticating and enhancing an insurance eligibility transaction, comprising:

• a first code segment for receiving an insurance eligibility transaction response having a coverage determination of whether an insurance eligibility request should be granted for a person and having eligibility terms for the person if a positive coverage determination is provided;
• a second code segment for querying ancillary data within an ancillary data database;
• a third code segment for determining whether demographic data and/or target personal information may have been used in a fraudulent manner and generating an alert if there is a positive determination;
• and,
• a fourth code segment for transmitting the insurance eligibility transaction response having the coverage determination and the alert therein to a healthcare provider.

A computer readable medium for execution on a computer processor, for authenticating and enhancing an insurance eligibility transaction, comprising:

• a first code segment for receiving an insurance eligibility transaction response having a coverage determination of whether an insurance eligibility request should be granted for a person;
• a second code segment for determining whether the person qualifies for third party subsidy payments if the coverage determination is less than a maximum threshold level;
• and,
• a fourth code segment for appending third party subsidy payment information to the insurance eligibility transaction response if the person qualifies for third party subsidy payments.

A computer readable medium for execution on a computer processor, for authenticating and enhancing an insurance eligibility transaction, comprising:

• a first code segment for receiving an insurance eligibility transaction response having coverage determination information comprising a determination of whether the insurance eligibility request should be granted for a person;
• a second code segment for estimating an amount of coverage based on coverage determination information provided within the insurance eligibility transaction response;
• and,
• a third code segment for appending the coverage estimation to the insurance eligibility transaction response.

A method performed by an insurance eligibility transaction authentication/enhancement computer, for authenticating and enhancing an insurance eligibility transaction, comprising the steps of:

• receiving an electronic insurance eligibility transaction request having target personal information for a person associated with the insurance eligibility transaction request;
• querying demographic data within a personal identity database stored within computer memory;
• determining whether the target personal information matches the demographic data within the personal identity database;
• and,
• transmitting the insurance eligibility transaction request having the verified personal information therein to a payor for determining whether the insurance eligibility request should be granted and for determining eligibility terms under which the insurance eligibility request should be granted.