System And Method To Adjust Eligibility For Health Plan Benefits
OwnerWilliam Kaafarani, Mohamad Bazziinventors
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Abstract
Changing eligibility for a plan benefit in a health plan includes transmitting an information request from a server computer system to a client computer of an enrollee, and determining via a processor of the server computer system predicted likelihood of misuse of a product delivered to the enrollee, responsive to data entered by the enrollee in satisfaction of the information request. The processor switches a flag setting based on the predicted likelihood, so as to adjust a record obligation of a third party payor under the health plan to pay for a product not yet delivered to the enrollee.
Claims20
A method of changing eligibility for a plan benefit of an enrollee in a health plan comprising the steps of:
- receiving on a server computer system a notification of a transaction on an account of the enrollee, where a third party payor is obligated under the health plan to pay for a product delivered via the transaction;
- transmitting an information request from the server computer system to a client device of the enrollee;
- receiving on the server computer system data entered in satisfaction of the information request;
- and
- switching a flag setting via the processor, responsive to the data, and being determinative of a record obligation of the third party payor under the health plan to provide a plan benefit not yet delivered to the enrollee.
A system for benefits administration in a health plan comprising:
- a server computer including a processor, a computer readable memory coupled with the processor, and inputs and outputs for receiving and transmitting data between the server computer and a communications network;
- the computer readable memory storing a control algorithm, in code executable by the processor, for changing eligibility for plan benefits of any one of a population of enrollees in the health plan;
- the server computer being configured to receive a notification transmitted over the communications network and being indicative of a transaction on an account of one of the enrollees, where a third party payor is obligated under the health plan to pay for a product delivered in the transaction;
- the server computer being further configured to transmit an information request over the communications network to a client device of the one of the enrollees, and to receive and store data entered in satisfaction of the information request;
- and
- the server computer being further configured, via execution of the code by the processor, to switch a flag setting determinative of a record obligation of the third party payor under the health plan to provide a plan benefit not yet delivered to the one of the enrollees, responsive to the data.
Dependencies are inferred from the claim text.