Methods and systems for adjudication and processing of claims

Abstract

Methods and systems process a request for reimbursement of an expense incurred from a service provider by a customer. A first electronic packet having the reimbursement request is received at a coordination system. The reimbursement request includes an identification of the customer, an identification of a reimbursement-account provider, and a reimbursement amount. A second electronic packet is transmitted from the coordination system to a provider platform maintained by or on behalf of the reimbursement-account provider. The second electronic packet includes the identification of the customer, the reimbursement amount, and information related to a service provided for the customer by the service provider. A third electronic packet is received from the provider platform at the coordination system. The third electronic packet comprises an approval of the reimbursement request. Instructions are issued with the coordination system to effect payment for the service by the reimbursement-account provider.

Description

BRIEF DESCRIPTION OF THE DRAWINGS

A further understanding of the nature and advantages of the present invention may be realized by reference to the remaining portions of the specification and the drawings wherein like reference numerals are used throughout the several drawings to refer to similar components. In some instances, a sublabel is associated with a reference numeral and follows a hyphen to denote one of multiple similar components. When reference is made to a reference numeral without specification to an existing sublabel, it is intended to refer to all such multiple similar components.

FIG. 1 is a schematic diagram illustrating an architecture within which methods of the invention may be performed;

FIG. 2 is a schematic diagram of a computational device on which methods of the invention may be embodied;

FIG. 3A is a flow diagram illustrating methods for processing a claim in accordance with embodiments of the invention;

FIGS. 3B-3E provide examples of screens that may be presented to a user in implementing the methods of FIG. 3A;

FIG. 4A is a flow diagram illustrating methods of managing claim information for a user in accordance with embodiments of the invention; and

FIG. 4B is an example of a screen that may be presented to a user in implementing the methods of FIG. 4A.

Claims

1. A method of processing a reimbursement request for reimbursement of an expense incurred from a service provider by a customer, the method comprising: receiving, at a coordination system, a first electronic packet that comprises the reimbursement request, the reimbursement request comprising an identification of the customer, an identification of a reimbursement-account provider, and a reimbursement amount;transmitting, from the coordination system to a provider platform maintained by or on behalf of the reimbursement-account provider, a second electronic packet that comprises the identification of the customer, the reimbursement amount, and information related to a service provided for the customer by the service provider;receiving, from the provider platform at the coordination system, a third electronic packet that comprises an approval of the reimbursement request; andissuing, with the coordination system, instructions to effect payment for the service by the reimbursement-account provider.

2. The method recited in claim 1 wherein issuing instructions to effect payment for the service comprises issuing instructions to effect payment to the customer.

3. The method recited in claim 1 wherein issuing instructions to effect payment for the service comprises issuing instructions to effect payment to the service provider.

4. The method recited in claim 1 wherein issuing instructions to effect payment for the service comprises issuing instructions to print a check payable to one of the customer and the service provider.

5. The method recited in claim 1 wherein issuing instructions to effect payment for the service comprises issuing instructions to a financial institution to perform an electronic transfer of funds from an account of the reimbursement-account provider to an account of one of the customer and the service provider.

6. The method recited in claim 1 wherein the first electronic packet further comprises an electronic document providing particulars of the service provided for the customer by the service provider.

7. The method recited in claim 6 wherein the electronic document comprises an electronic receipt or invoice.

8. The method recited in claim 6 further comprising storing a copy of the electronic document.

9. The method recited in claim 8 further comprising: receiving, at the coordination system, a request for a copy of the electronic document;retrieving, with the coordination system, the stored copy of the electronic document; andtransmitting, from the coordination system, a copy of the retrieved copy of the electronic document.

10. The method recited in claim 1 further comprising: receiving, at the coordination system, a fourth electronic packet that comprises a second reimbursement request, the second reimbursement request comprising an identification of a second customer, an identification of a second reimbursement-account provider, and a second reimbursement amount;transmitting, from the coordination system to a second provider platform maintained by or on behalf of the second reimbursement-account provider, a fifth electronic packet that comprises the identification of the second customer, the second reimbursement amount, and information related to a second service provided for the second customer by a second service provider; andreceiving, from the second provider platform at the coordination system, a sixth electronic packet that comprises a denial of the second reimbursement request.

11. The method recited in claim 1 wherein receiving the first electronic packet comprises receiving the first electronic packet over a public communications network from the customer.

12. The method recited in claim 1 further comprising: receiving, at the coordination system, a fourth electronic packet that comprises the identification of the customer, the identification of the reimbursement-account provider, an identification of a reimbursement account maintained by the reimbursement-account provider, and a specification of a payment preference; andinitializing a coordination account that associates the identification of the customer with the identification of the reimbursement-account provider and that maintains the identification of the reimbursement account and the specification of the payment preference.

13. The method recited in claim 1 further comprising monitoring, with the coordination system, a balance available to the customer in a reimbursement account maintained by the reimbursement-account provider on behalf of the customer.

14. A method of managing reimbursement requests for reimbursement of expenses incurred from service providers by a customer, the method comprising: receiving, at a coordination system from the customer over a public communications network, a first electronic packet that comprises an identification of the customer, an identification of at least one reimbursement-account provider, an identification of a reimbursement account maintained by the at least one reimbursement-account provider, and a specification of a payment preference, wherein the payment preference is selected from the group consisting of preparing a check payable to the customer and performing an electronic transfer of funds to an account maintained on behalf of the customer;initializing a coordination account that associates the identification of the customer with the identification of the at least one reimbursement-account provider and that maintains the identification of the reimbursement account and the specification of the payment preference;receiving, at the coordination system from the customer over the public communications network, a second electronic packet that comprises a first reimbursement request, the first reimbursement request comprising the identification of the customer, an identification of one of the at least one reimbursement-account provider, a first reimbursement amount, and a first electronic receipt itemizing details of one or more services provided for the customer by one or more of the service providers;transmitting, from the coordination system to a first provider platform maintained by or on behalf of the one of the at least one reimbursement-account provider, a third electronic packet that comprises the identification of the customer, the first reimbursement amount, and the first electronic receipt;storing, with the coordination system, a copy of the first electronic receipt and associating the stored copy with the coordination account associated with the customer;receiving, from the first provider platform at the coordination system, a fourth electronic packet that comprise an approval of the first reimbursement request;issuing, with the coordination system, instructions to effect payment for the service to the customer by the one of the at least one reimbursement-account provider according to the specification of the payment preference.

15. The method recited in claim 14 further comprising: receiving, at the coordination system from the customer over the public communications network, a fifth electronic packet that comprises a second reimbursement request, the second reimbursement request comprising the identification of the customer, an identification of a second of the at least one reimbursement-account provider, a second reimbursement, and a second electronic receipt itemizing details of one or more services provided for the customer by one or more of the service providers;transmitting, from the coordination system to a second provider platform maintained by or on behalf of the second of the at least one reimbursement-account provider, a sixth electronic packet that comprises the identification of the customer, the second reimbursement amount, and the second electronic receipt;storing, with the coordination system, a copy of the second electronic receipt and associating the stored copy of the second electronic receipt with the coordination account associated with the customer; andreceiving, from the second provider platform at the coordination system, a seventh electronic packet that comprises a decision on the second reimbursement request, the decision being selected from the group consisting of an approval and a denial.

16. The method recited in claim 15 further comprising: receiving, at the coordination system from the customer over the public communications network, a request for copies of the first and second electronic receipts;retrieving, with the coordination system, the stored copy of the first electronic receipt and the stored copy of the second electronic receipt; andtransmitting, from the coordination system to the customer over the public communications network, copies of the retrieved copy of the first electronic receipt and of the retrieved copy of the second electronic receipt.

17. A system for processing a reimbursement request for reimbursement of an expense incurred from a service provider by a customer, the system comprising: a communications device;a processor;a storage device; anda 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 to process the reimbursement request, the computer-readable program including:instructions for receiving, with the communications system, a first electronic packet that comprises the reimbursement request, the reimbursement request comprising an identification of the customer, an identification of a reimbursement-account provider, and a reimbursement amount;instructions for transmitting, with the communications system to a provider platform maintained by or on behalf of the reimbursement-account provider, a second electronic packet that comprises the identification of the customer, the reimbursement amount, and information related to a service provided for the customer by the service provider;instructions for receiving, with the communications system from the provider platform, a third electronic packet that comprises an approval of the reimbursement request; andinstructions for effecting payment for the service by the reimbursement-account provider.

18. The system recited in claim 17 wherein the instructions for effecting payment for the service comprise instructions for effecting payment to the customer.

19. The system recited in claim 17 wherein the instructions for effecting payment for the service comprise instructions for effecting payment to the service provider.

20. The system recited in claim 17 wherein the instructions for effecting payment for the service comprise instructions to print a check payable to one of the customer and the service provider.

21. The system recited in claim 17 wherein the instructions for effecting payment for the service comprise instructions to a financial institution to perform an electronic transfer of funds from an account of the reimbursement-account provider to an account of one of the customer and the service provider.

22. The system recited in claim 17 wherein the first electronic packet further comprises an electronic document providing particulars of the service provided for the customer by the service provider.

23. The system recited in claim 22 wherein the electronic document comprises an electronic receipt or invoice.

24. The system recited in claim 22 wherein the computer-readable program further includes instructions for storing a copy of the electronic document on the storage device.

25. The system recited in claim 24 wherein the computer-readable program further includes: instructions for receiving, with the communications system, a request for a copy of the electronic document;instructions for retrieving, from the storage device, the stored copy of the electronic document; andinstructions for transmitting, with the communications system, a copy of the retrieved copy of the electronic document.

26. The system recited in claim 17 wherein the computer-readable program further includes: instructions for receiving, with the communications system, a fourth electronic packet that comprises a second reimbursement request, the second reimbursement request comprising an identification of a second customer, an identification of a second reimbursement-account provider, and a second reimbursement amount;instructions for transmitting, with the communications system to a second provider platform maintained by or on behalf of the second reimbursement-account provider, a fifth electronic packet that comprises the identification of the second customer, the second reimbursement amount, and information related to a second service provided for the second customer by a second service provider; andinstructions for receiving, with the communications system from the second provider platform, a sixth electronic packet that comprises a denial of the second reimbursement request.

27. The system recited in claim 17 wherein the communications system is interfaced with a public communications network.

28. The system recited in claim 17 wherein the computer-readable program further includes: instructions for receiving, with the communications system, a fourth electronic packet that comprises the identification of the customer, the identification of the reimbursement-account provider, an identification of a reimbursement account maintained by the reimbursement-account provider, and a specification of a payment preference; andinstructions for initializing a coordination account that associates the identification of the customer with the identification of the reimbursement-account provider and that maintains the identification of the reimbursement account and the specification of the payment preference.

29. The system recited in claim 17 wherein the computer-readable program further comprises instructions for monitoring a balance available to the customer in a reimbursement account maintained by the reimbursement-account provider on behalf of the customer.