Methods, systems, and computer program products for discovering patient benefits under a health care coverage plan

A system, comprising:

• a processor;
• and
• a memory coupled to the processor and comprising computer readable program code embodied in the memory that is executable by the processor to perform operations comprising:
• receiving a patient health care benefit query from a requestor;
• generating a health care coverage eligibility request for the patient;
• communicating the health care coverage eligibility request to a payor;
• electronically updating a benefit rule repository with information from an eligibility confirmation response from the payor;
• adjudicating one or more rules, which are based on a health care coverage policy provided by the payor for the patient, contained in the benefit rule repository;
• determining a benefit eligibility result for the patient based on adjudicating the one or more rules;
• and
• communicating the benefit eligibility result to the requestor.

A computer program product, comprising:

• a non-transitory computer readable storage medium comprising computer readable program code embodied in the medium that is executable by a processor to perform operations comprising:
• receiving a patient health care benefit query from a requestor;
• generating a health care coverage eligibility request for the patient;
• communicating the health care coverage eligibility request to a payor;
• electronically updating a benefit rule repository with information from an eligibility confirmation response from the payor;
• adjudicating one or more rules, which are based on a health care coverage policy provided by the payor for the patient, contained in the benefit rule repository;
• determining a benefit eligibility result for the patient based on adjudicating the one or more rules;
• and
• communicating the benefit eligibility result to the requestor.