Patent ID: 8515784
Filing Date: 2013-08-20
Classification: G06Q

Abstract:
1. A claims processing system for processing health care reimbursement plan claims, said system comprising at least one processor configured to: receive one or more rules from a health care reimbursement plan administrator indicating information required to substantiate the claims; receive from a health care provider, via a communications network, a claim to pay at least a portion of a cost associated with a purchase for a health care-related service or product provided by said health care provider; determine that said claim comprises a customer identifier associated with a customer, a health care reimbursement plan account identifier associated with a health care reimbursement plan account that covers monetary expenses uncovered by a primary insurance plan, a primary health care plan identifier associated with said primary insurance plan, or an amount requested to be paid associated with the cost; determine whether the account is eligible and whether a balance of the account is greater than or equal to a portion of the amount, in response to determining that the portion of the amount is uncovered by the primary insurance plan; in response to determining that the account is eligible and that the balance is greater than or equal to the portion of the amount, automatically determine whether said claim is sufficiently substantiated, based on a comparison of the information in the claim and the rules, to verify whether the purchase qualifies as a valid purchase according to the account; in response to verifying that said claim is sufficiently substantiated, generate an approval response message for transmitting to said health care provider over said communications network, the approval response message comprises information indicating that the portion of the amount is approved; and in response to said claim not being sufficiently substantiated, generate a denial response message for transmitting to said health care provider over said communications network, wherein said communications network comprises one or more non-banking networks.