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US 2014/0229203 A1Published application
Pre-paid and closed loop transaction system
AssigneeDatavi, LLC
InventorsDavid B Dean, Randy G San Nicolas
Life of this patent
Estimating the term…
Abstract
A method for processing transactions comprising receiving transaction data. Electronically determining whether to process the transaction data as a pre-paid transaction or a closed loop transaction using data processing equipment. Processing the transaction using pre-paid network rules if it is determined that the transaction data defines the pre-paid transaction. Processing the transaction using closed loop transaction rules if it is determined that the transaction data defines the closed loop transaction. Scheduling payment as a function of whether the transaction data was processed as the pre-paid transaction or the closed transaction. Generating an explanation of benefits after the payment is scheduled.
Claims20
A method for processing transactions comprising:
- receiving transaction data containing a plurality of data fields;
- automatically generating one or more health service provider accounts and one or more patient accounts using the plurality of data fields of the transaction data.
- electronically determining whether to process the transaction data as a pre-paid transaction or a closed loop transaction using data processing equipment;
- processing the transaction using pre-paid network rules if it is determined that the transaction data defines the pre-paid transaction;
- processing the transaction using closed loop transaction rules if it is determined that the transaction data defines the closed loop transaction;
- scheduling payment to one of the health service provider accounts as a function of whether the transaction data was processed as the pre-paid transaction or the closed transaction;
- and
- transmitting explanation of benefits data to one of the patient accounts after the payment is scheduled.
5 more elements
A system for processing transactions comprising:
- an insurance gateway for receiving electronic transaction data using an electronic data processing system;
- a pre-paid card system for processing the transaction data if a health services provider associated with the transaction data has a pre-paid card account;
- and
- a closed loop transaction system for processing the transaction data if the health services provider associated with the transaction data has a closed loop account.
1 more element
A system for processing transactions comprising:
- a plurality of insurance company electronic data processing systems;
- a plurality of health services provider systems;
- an insurance services platform coupled to the plurality of insurance company electronic data processing systems and the plurality of health services provider systems, the insurance services platform further comprising:
- a pre-paid card system for processing pre-paid card transactions, the pre-paid card system further comprising:
- a pre-paid cardholder account management system for managing a plurality of pre-paid cardholder accounts associated with the plurality of health service provider systems;
- an authorization and settlement system for authorizing and settling pre-paid card transactions associated with the plurality of pre-paid cardholder accounts;
- a card management and fulfillment system for issuing and managing a plurality of pre-paid cards associated with the plurality of pre-paid cardholder accounts;
- and
- a reporting system for generating activity report data associated with transactions for selected pre-paid cardholder accounts;
- an explanation of benefits (EOB) and payment system for processing explanation of benefits data and payment data, the EOB and payment system further comprising:
- an EOB batch processing system for receiving batch transaction data from the plurality of insurance company electronic data processing systems and processing the batch transaction data as a function of health services provider data and patient data for each of a plurality of records in the batch transaction data;
- a payment consolidation system for receiving the processed batch transaction data and consolidating payment data for the plurality of health services providers;
- a health services provider and patient data system for receiving the processed batch transaction data and providing predetermined specific data associated with the health services providers to the health services providers and providing predetermined specific data associated with a plurality of patients to the patients;
- and
- an EOB to electronic data interchange (EDI) translation system translating EOB data in a proprietary format to a standardized EDI data format;
- a migrated services system for migrating the health services provider systems from pre-paid card accounts to closed loop system accounts, the migrated services system further comprising:
- an account migration system for closing the pre-paid card account of the health services provider and opening a closed loop processing account for the health services provider;
- a bank account management system for receiving automated clearinghouse (ACH) data for insurance company bank accounts and health services provider bank accounts and controlling access to the ACH data;
- a closed loop authorization and settlement system for receiving closed loop transaction authorization request data and closed loop transaction settlement request data and generating closed loop transaction authorization approval data and closed loop transaction settlement approval data;
- and
- a transaction history system for storing closed loop transaction data for each of a plurality of closed loop transactions associated with each of a plurality of health services providers;
- an insurance gateway for receiving electronic transaction data from a plurality of insurance companies using an electronic data processing system;
- a health services provider gateway for providing electronic transaction data and payment data to a plurality of health services providers;
- and
- a patient gateway for providing EOB data to a plurality of patients and to support messaging between the health services providers and the patients;
- a plurality of patient interfaces coupled to the insurance services platform for allowing patients to access predetermined EOB data associated with each patient and for allowing messaging between the health services providers and the patients;
- a plurality of banks coupled to the insurance services platform, wherein the insurance services platform can access accounts at the plurality of banks using the ACH data and an ACH network;
- and
- a credit card network coupled to the insurance services platform, wherein the insurance services platform can access credit card accounts over the credit card network to support processing of pre-paid card transactions.
26 more elements
Dependencies are inferred from the claim text.