Systems and Methods for Cross-border Health Insurance

A computing device, comprising:

• a processor configured with processor-executable software instructions to perform operations comprising:
• receiving a service eligibility request from a first computing system in a first location, wherein the service eligibility request identifies:
• an adherent;
• a proxy guarantor;
• a policy;
• a healthcare service;
• and
• a disease code of a first disease code system;
• determining a disease-related condition associated with the disease code;
• determining whether the policy is associated with a second location;
• determining whether the second location uses a different disease code system than the first disease code system in response to determining that the policy is associated with the second location;
• generating a proxy service eligibility request based on the received service eligibility request in response to determining that the policy is associated with the second location, wherein the proxy service eligibility request replaces an identifier of a healthcare provider with an identifier of a proxy provider;
• sending the proxy service eligibility request and the determined disease-related condition to a second computing system in the second location;
• receiving a proxy healthcare approval confirmation message in response to sending the proxy service eligibility request to the second computing system in the second location;
• generating a healthcare approval message based on a combination of:
• information included in the proxy healthcare approval confirmation message received from the second computing system;
• information included in the service eligibility request received from the first computing system;
• and
• information stored in memory;
• and
• sending the generated healthcare approval message to the first computing system to enable the first computing system to provide the healthcare service to the adherent.

A non-transitory computer readable storage medium having stored thereon processor-executable software instructions configured to cause a processor in a computing device to perform operations comprising

• receiving a service eligibility request from a first computing system in a first location, wherein the service eligibility request identifies:
• an adherent;
• a proxy guarantor;
• a policy;
• a healthcare service;
• and
• a disease code of a first disease code system;
• determining a disease-related condition associated with the disease code;
• determining whether the policy is associated with a second location;
• determining whether the second location uses a different disease code system than the first disease code system in response to determining that the policy is associated with the second location;
• generating a proxy service eligibility request based on the received service eligibility request in response to determining that the policy is associated with the second location, wherein the proxy service eligibility request replaces an identifier of a healthcare provider with an identifier of a proxy provider;
• sending the proxy service eligibility request and the determined disease-related condition to a second computing system in the second location;
• receiving a proxy healthcare approval confirmation message in response to sending the proxy service eligibility request to the second computing system in the second location;
• generating a healthcare approval message based on a combination of:
• information included in the proxy healthcare approval confirmation message received from the second computing system;
• information included in the service eligibility request received from the first computing system;
• and
• information stored in a memory coupled to the computing device;
• and
• sending the generated healthcare approval message to the first computing system to enable the first computing system to provide the healthcare service to the adherent.