Methods and systems for substantiation of healthcare expenses
AssigneeMetavante Corporation
InventorMargaret A. Boyle
Life of this patent
Estimating the term…
Abstract
Methods and systems are disclosed for processing a request to fund a purchase from a provider with a medical expense account. The request identifies expenses incurred with the purchase is received at a substantiation system and used to identify the provider. A determination is made whether the provider is included in a presubstantiation list, which identifies a set of providers determined to provide only goods and/or services eligible for funding by medical expense accounts. In response to a determination that the provider is included in the presubstantiation list, the expenses are automatically substantiated and substantiation information is generated and transmitted to a third-party administrator.
Claims23
A method of processing a request to fund a purchase from a provider with a medical expense account, the method comprising:
- receiving a request at a substantiation system, the request comprising an identification of expenses incurred with the purchase;
- identifying, using a processor, a provider from the received request with the substantiation system;
- determining, using the processor, whether the provider is included in a presubstantiation list with the substantiation system, the presubstantiation list comprising at least one provider that provides only goods or services eligible for funding by medical expense accounts;
- and
- in response to a determination that the provider is included in the presubstantiation list,
- automatically substantiating the expenses with the substantiation system based on the provider's inclusion in the presubstantiation list;
- generating substantiation information with the substantiation system;
- and
- transmitting the generated substantiation information from the substantiation system to a third-party administrator, and
- in response to a determination that the provider is not included in the presubstantiation list, determining, using the processor, that the provider is included in a secondary list with the substantiation system, the secondary list identifying eligible goods or services.
A system for processing a request to fund a purchase from a provider with a medical expense account, the system comprising:
- a communications system;
- a storage device, the storage device maintaining a presubstantiation list comprising at least one provider that provides only goods or services eligible for funding by medical expense accounts and a secondary list identifying eligible goods or services;
- a processor in communication with the communications system and with the storage device;
- and
- a memory coupled with the processor, the memory comprising a computer-readable medium having a computer-readable program embodied therein for directing operation of the system, the computer-readable program including:
- instructions for receiving the request with the communications system, the request comprising an identification of expenses incurred with the purchase;
- instructions for identifying the provider from the received request with the processor;
- instructions for determining whether the provider is included in the presubstantiation list with the processor;
- instructions for automatically substantiating the expenses with the processor based on the provider's inclusion in the presubstantiation list;
- instructions for generating substantiation information with the processor;
- instructions for transmitting the generated substantiation information from the system to a third-party administrator with the communications system;
- and
- instructions for determining that the provider is included in the secondary list with the processor,
- wherein the instructions for automatically substantiating the expenses, for generating substantiation information, and for transmitting the generated substantiation information are to be executed in response to a determination that the provider is included in the presubstantiation list;
- and
- wherein the instructions for determining that the provider is included in the secondary list is to be executed in response to a determination that the provider is not included in the presubstantiation list.
Dependencies are inferred from the claim text.