Patent Application
20050121511
Currently, it is common practice for an individual to use a credit card to make reimbursable purchases such as reimbursable health care or business-related purchases. For example, an individual can use their credit card to pay a co-payment for a medical checkup that is reimbursable from the individual's flexible spending account, or to purchase tickets for reimbursable employment-related travel. In order to obtain reimbursement for such purchases, the individual must typically fill out an appropriate paper form and submit it, along with proper substantiating documentation, to an appropriate entity such as a flexible spending account administrator. This process is often difficult and time consuming. Accordingly, an improved reimbursement system is needed to make it easier to obtain reimbursement payments for reimbursable purchases.
A credit card transaction processing system according to one embodiment of the invention is configured for: (1) receiving transaction data related to a reimbursable charge made on the credit card by a credit card holder; (2) analyzing the transaction data to determine whether the charge may be auto-substantiated; (3) in response to determining that the charge may be auto-substantiated, auto-substantiating the charge; and (4) in response to the charge being auto-substantiated, reimbursing the credit card holder for at least a portion of the charge at least substantially without human intervention.
A credit card transaction processing system according to a further embodiment of the invention is configured for: (1) receiving transaction information regarding a credit card transaction related to a reimbursable charge made on a credit card by a credit card holder; (2) determining that the credit card transaction would qualify for reimbursement from a first account; (3) determining that the credit card transaction would also qualify for reimbursement from a second account; and (4) determining, based at least in part on the transaction information, to reimburse at least a portion of the credit card transaction from the first account.
A credit card transaction processing system according to yet another embodiment of the invention is configured for processing transactions made on a credit card that is issued to a cardholder and guaranteed by the cardholder's employer.
The present invention now will be described more fully with reference to the accompanying drawings, in which some, but not all embodiments of the invention are shown. Indeed, this invention may be embodied in many different forms and should not be construed as limited to the embodiments set forth herein. Rather, these embodiments are provided so that this disclosure will satisfy applicable legal requirements. Like numbers refer to like elements throughout.
As will be appreciated by one skilled in the art, various embodiments of the present invention may be, for example, a method, a data processing system, a financial payment card (such as a credit card, a debit card, or a pre-paid card), or a computer program product. Accordingly, the present invention may take the form of an entirely hardware embodiment, an entirely software embodiment, or an embodiment combining software and hardware aspects. The invention may also take the form of a unique credit card or a related method of doing business. Furthermore, the present invention may take the form of a computer program product on a computer-readable storage medium having computer-readable program instructions (e.g., computer software) embodied in the storage medium. More particularly, the present invention may take the form of web-implemented computer software. Any suitable computer-readable storage medium may be utilized including hard disks, CD-ROMs, optical storage devices, or magnetic storage devices.
The present invention is described below with reference to block diagrams and flowchart illustrations of methods, apparatuses (i.e., systems) and computer program products according to various embodiments of the invention. It will be understood that each block of the block diagrams and flowchart illustrations, and combinations of blocks in the block diagrams and flowchart illustrations, respectively, can be implemented by computer program instructions. These computer program instructions may be loaded onto a general purpose computer, special purpose computer, or other programmable data processing apparatus to produce a machine, such that the instructions that execute on the computer or other programmable data processing apparatus create a system for implementing the functions specified in the flowchart block or blocks.
These computer program instructions may also be stored in a computer-readable memory that can direct a computer or other programmable data processing apparatus to function in a particular manner, such that the instructions stored in the computer-readable memory produce an article of manufacture including computer-readable instructions for implementing the function specified in the flowchart block or blocks. The computer program instructions may also be loaded onto a computer or other programmable data processing apparatus to cause a series of operational steps to be performed on the computer or other programmable apparatus to produce a computer-implemented process such that the instructions that execute on the computer or other programmable apparatus provide steps for implementing the functions specified in the flowchart block or blocks.
Accordingly, blocks of the block diagrams and flowchart illustrations support combinations of means for performing the specified functions, combinations of steps for performing the specified functions and program instruction means for performing the specified functions. It will also be understood that each block of the block diagrams and flowchart illustrations, and combinations of blocks in the block diagrams and flowchart illustrations, can be implemented by special purpose hardware-based computer systems that perform the specified functions or steps, or combinations of special purpose hardware and computer instructions.
Brief Overview
A reimbursement system according to one embodiment of the invention includes a transaction processing system that automatically submits and processes reimbursement requests for particular types of charges made on a particular credit card. For example, in one embodiment of the invention, a cardholder may use their credit card to pay certain reimbursable charges related to health care, travel, entertainment, dependent care, parking, or transit use. The transaction processing system then automatically identifies the charges as reimbursable, automatically substantiates the charges, and arranges for reimbursement from one or more appropriate responsible payment sources. In one embodiment of the invention, once a particular charge has been substantiated, the system deducts the amount of the charge from an appropriate payment account (e.g., a flexible spending, dependent care account, parking account, or travel account) and then reimburses the charge directly to an account associated with the credit card used to make the charge. This can eliminate the need for the user to submit reimbursement requests for particular reimbursable charges.
In a particular embodiment, the credit card may also be used to pay for non-reimbursable charges and for reimbursable charges that do not qualify for automatic substantiation. In one embodiment, non-reimbursable charges are treated as standard credit card charges for which the cardholder is responsible. In a particular embodiment, for reimbursable charges that do not qualify for auto-substantiation based on information obtained from the transaction, the user may submit additional substantiation materials (e.g., via an appropriate paper or electronic submission) for processing by the system. In a particular embodiment, once the substantiation materials are used to properly substantiate the transaction, the amount of the related charge is then reimbursed directly to the customer's credit card. Alternatively, at least part of the charge (and in some embodiments, all of the charge) is reimbursed directly to the individual.
Also, in various embodiments, the system is configured to allow users to manually associate particular charges with a particular payment source. Users may do this, for example, via an appropriate web site. In one embodiment, once a user (e.g., a cardholder) associates a particular charge with a particular payment source, the system processes the payment as if the system had automatically identified the charge as being potentially reimbursable from the payment source indicated by the user.
The structure and operation of the system will now be described in greater detail.
Structure of Exemplary System
A system 5 according to one embodiment of the invention is shown in
In addition, the reimbursement server 50 includes at least one storage device 63, such as a hard disk drive, a floppy disk drive, a CD Rom drive, or optical disk drive, for storing information on various computer-readable media, such as a hard disk, a removable magnetic disk, or a CD-ROM disk. As will be appreciated by one of ordinary skill in the art, each of these storage devices 63 is connected to the system bus 61 by an appropriate interface. The storage devices 63 and their associated computer-readable media provide nonvolatile storage for a personal computer. It is important to note that the computer-readable media described above could be replaced by any other type of computer-readable media known in the art. Such media include, for example, magnetic cassettes, flash memory cards, digital video disks, and Bernoulli cartridges.
A number of program modules may be stored by the various storage devices and within RAM 67. Such program modules include an operating system 80, a substantiation module 200 and a reimbursement module 300. As described in more detail below, the substantiation module 200 and the reimbursement module 300 control certain aspects of the operation of the reimbursement server 50, with the assistance of the processor 60 and an operating system 80.
Also located within the reimbursement server 50 is a network interface 74, for interfacing and communicating with other elements of a computer network. It will be appreciated by one of ordinary skill in the art that one or more of the reimbursement server 50 components may be located geographically remotely from other reimbursement server 50 components. Furthermore, one or more of the components may be combined, and additional components performing functions described herein may be included in the reimbursement server 50.
Operation of an Exemplary System
Next, at Step 115, the issuing bank debits the credit card account by the amount of the purchase and transfers appropriate payment to the merchant for the purchase. At Step 120, the Administration Server 40 then identifies a reimbursement system associated with the credit card and routes the transaction data to the identified reimbursement system. Next, at Steps 125 and 130, the Reimbursement System receives the transaction data and executes the Substantiation Module 200.
In one embodiment of the invention, the Administration server 40 delays performing this step until a specified time, when it routes the transaction data to the transaction routing server as part of a data stream containing a larger set of transaction data to be processed by the identified reimbursement system.
Turning to
If the system determines, at Step 205, that the transaction qualifies for auto-substantiation (e.g., if the transaction data for the transaction satisfies one or more of the sets of auto-substantiation criteria), the system advances to Step 210, where it executes a reimbursement module, such as the reimbursement module 300 depicted in
As may be understood from
Next, at Step 310, the system determines the amount to be reimbursed (the “Reimbursable Amount”) from the account at issue. In one embodiment of the invention, the system makes this determination based on one or more of the following factors: (1) the amount of money left in the particular account; and (2) the rules established for payment of transactions out of the account. For example, if the transaction amount is $300, and only $200 remain in the applicable account, in one embodiment of the invention, the reimbursement amount will be $200 (the amount remaining in the account). Similarly, if the transaction amount is $300, but the rules associated with the account specify that the maximum payment for the type of transaction at issue (e.g., an airplane ticket) is $250, the reimbursement amount will be $250 (the maximum amount payable for the transaction).
After the system determines the appropriate reimbursement amount, the reimbursement system proceeds to step 315 where it determines the balance on the cardholder's credit card account (e.g., by requesting this information from the appropriate Sponsor Bank). Next, the system proceeds to Step 320 where it determines whether there is a zero balance on the cardholder's credit card account. If so, the system proceeds to Step 325, where it sends the reimbursement amount to the cardholder. The system may do this, for example, via a paper check or an electronic transfer of funds into a specified account.
If the system determines, at Step 320, that there is not a zero balance on the cardholder's credit card account, the system advances to Step 330 where it determines whether the balance on the cardholder's credit card account is less than the reimbursement amount. If so, the system advances to Step 335, where it: (1) makes a payment to the cardholder's credit card account equal to the current balance of the account (e.g., via an electronic transfer of funds, or by paper check); and (2) sends the remaining balance of the reimbursement amount to the cardholder. As noted above, the system may do this, for example, via a paper check or an electronic transfer of funds into a specified account.
If the system determines, at Step 330, that the cardholder's credit card account balance is not less than the reimbursement amount, the system proceeds to step 340, where it makes a payment to the cardholder's credit card account for the entire reimbursement amount.
In one embodiment of the invention, the system is configured to reimburse a single particular transaction from two or more accounts. For example, to determine which account should be used to reimburse a particular charge, the system access data (e.g., data stored in a database) indicating which of two particular accounts is the preferred account from which payments of a particular type are to be made. In this case, payments would first be made to the extent allowable and available from the preferred account (e.g., based on the preferred account's balance, and the rules associated with the preferred account). However, any remaining balance on the transaction would be made from the second account to the extent possible based upon the balance left in the second account and the payment rules associated with the second account. In one embodiment of the invention, such payments for each account would generally be made in the manner discussed above in regard to Steps 315-340 of
For example, the system may be set up to pay certain transactions that are eligible for reimbursement from both a health care flexible spending account (FSA) and a health reimbursement arrangement (HRA) so that: (1) the transactions are reimbursed to the greatest extent possible from the FSA account; and (2) any remaining transaction balance is reimbursed, to the extent allowable, from the HRA account. As discussed above, the cardholder would be responsible for paying any amount not reimbursed by the reimbursement system.
Returning to
The cardholder may then submit the additional substantiation documentation in response to being notified that additional substantiation materials are required. In one embodiment of the invention, the cardholder may do this electronically. For example, in one embodiment, the cardholder may access a web site displaying their credit card account information and read a message indicating that the system needs a copy of a recent Explanation of Benefits form (EOB) in order to substantiate a recent health care related charge for reimbursement from the cardholder's flexible spending account. The cardholder may then submit the appropriate EOB for processing (e.g., either by sending a paper copy of the EOB to an appropriate plan administrator, or by arranging for the electronic submission of the EOB to the system.) In one embodiment of the invention, a web site associated with the credit card account is configured to allow users to view copies of their recent EOB forms and to electronically transmit those forms to the system for processing. In a particular embodiment, because the EOB is submitted electronically, the system may receive the EOB, and then use the EOB to substantiate the transaction substantially without human intervention. (Similar techniques may be used to allow users to view and process electronic transaction feed information from a Pharmacy Benefits Manager, a TPA, or an Insurance Carrier).
Detailed Discussion of Exemplary Embodiment
A more specific embodiment of the invention, which is shown in
At Step (3), if the Employer line of credit is approved, the Employer-designated employees complete individual applications for credit cards and submit the applications for card issuance. Next, at Step (4), credit cards are then issued by the bank to participating employees. At Step (5), an employee then uses their issued credit card at a qualified merchant (e.g., a health care provider). In one embodiment, use of the credit card for non-qualified expenses and at non-qualified merchants is permitted, but such charges are ineligible for automatic reimbursement from an Employer plan (such as a health care account, a travel expense account, or a parking account), and must be paid off by the employee pursuant to the applicable employee cardholder agreement (or by the Employer upon default by the employee).
At Step (6), the Healthcare Provider (or other merchant) receives payment from the bank. Next, at Step (7), as a result of the transaction, the Employee is obligated to the bank as recorded in the credit card cardholder agreement. In one embodiment, the set of agreements is a trilateral arrangement between the Employer, the employee, and the bank. In a particular embodiment of the invention, according to the cardholder agreement's default process, if the employee defaults, then the Employer guarantee will be used to pay off the credit card balance. In one embodiment, default is defined under the terms of the cardholder agreement as a failure to pay off the non-qualified balance (either by payment or submission of adequate substantiation resulting in payment from an appropriate Plan) within a specified number of billing cycles.
At Step (8), a card processor (such as Fiserv) separately creates a daily file containing information about transactions and sends this daily file to a central computer (e.g., a server associated with myRSC.com, which in one embodiment, is an example of an administration server). Next, At Step (9), the central computer then aggregates all the transactions by the Employer and makes them available to the Employer's Plan Service Provider (PSP) (e.g., as a data feed) to become possible claims against the employees' reimbursement plans (e.g., health care accounts, travel expense accounts, parking accounts, and/or child care accounts).
At Step (10) transaction data is compared to the plan parameters of the employee's elected plans. Based on IRS Guidance (such as Rev. Ruling 2003-43 and similar rulings) the reimbursement administration system determines whether the transaction is a claim that needs further substantiation. In many cases, the transaction can be substantiated by comparing the post authorization transaction's data to the reimbursement plan's automatic substantiation parameters. These transactions need no further paper substantiation, increasing efficiency and convenience to the employee.
As an aside, in various embodiments of the invention, the various automatic substantiation parameters may be defined, for example, by one or more of the following parties: (1) the employer; (2) the relevant TPA; or (3) the employee. In addition, these parameters may be defined to apply to: (1) all employers for which plans are administered by the TPA; (2) all employees of a particular employer; and/or (3) individual employees. In cases where the parameters are defined to apply to all employees for a particular employee, in one embodiment, the system is configured for allowing exceptions to be made to the general rule. Accordingly, different “customized” parameters could defined to apply to selected employees.
Similarly, in cases where the parameters are defined to apply to all employers for a particular TPA, in one embodiment, the system is configured for allowing exceptions to be made to the general rule. Accordingly, different “customized” parameters could defined to apply to selected employers.
At Step (11), if the transaction needs further substantiation, the employee is notified (e.g., by electronic means) and an opportunity to submit additional substantiation to the Plan Service Provider is provided (e.g., via a graphical user interface). Where adequate supporting substantiation is provided, reimbursements can be made directly to the employee's credit card account. This results in both an increased operational efficiency to the program and convenience to the employee.
At Step (12), upon adjudication against the employee's reimbursement plan, the reimbursable amount of the transaction is determined. If the employee has an outstanding card balance with the bank, then the reimbursement is directed to the employee credit card account. Otherwise, reimbursement is made to the employee.
At Step (13), the card processor sends a statement file to the central computer (e.g., myRSC.com), and the central computer (e.g., myRSC.com) then sends a statement to the employee.
At Step (14), the employee (a referred to in this figure as “CH”, or cardholder) reviews the statement and makes payment (if there is a remaining balance). In one embodiment of the invention, for any charges that are not reimbursed by an appropriate reimbursement account, the employee may have a second opportunity to provide adequate substantiation to the Plan Service Provider to relieve the balance via a reimbursement from an appropriate reimbursement account. Alternatively, the employee may have until the expiration of a pre-determined number of billing cycles, or until an event of “default” occurs, to pay off the non-qualified balance. If a default event occurs, the Employer may, pursuant to the applicable cardholder agreement, withhold money from the employee's future paychecks until the employee's balance is paid off, or may engage in other collection activities as allowed under applicable law.
Next, at Step (15), payment information is sent to the central computer (e.g., the myRSC.com web server). Finally, at Step (16), the central computer sends a monetary file to the card processor to update the account balances.
Graphical User Interface
As noted above, in one embodiment of the invention, the reimbursement and payment system includes a graphical user interface that allows the employee, employer, and plan administrator to access the system. In a particular embodiment, the employee can use this interface to: (1) view their various account balances (e.g., the account balances on their various health care accounts, entertainment accounts, parking accounts, travel accounts, and dependent care accounts); (2) view recent Explanation of Benefits (EOB) summaries; (3) submit additional substantiation information for a transaction; (4) recategorize transactions marked as “non-reimbursable” as “reimbursable”; or (5) change the pre-assigned account for a particular transaction to an alternate account; and (6) allocate portions of a transaction to two or more reimbursable accounts. In one embodiment, at least one of the accounts is funded, at least in part, by the employer. The interface, according to one embodiment, may further allow the employee to make online payments to the credit card account. (See
In a particular embodiment, the plan administrator or the employer can use the interface to view employee account balances, summaries, and pending transactions. The interface also provides the employer or plan administrator with a search engine to search for account records, such records regarding accounts with overdue balances or transactions made to certain merchants or health care providers. (See
For example, as depicted in
One particular embodiment includes an interface that allows employees to view their card account balances (See
As mentioned above, one embodiment of the invention includes an interface that allows the employee to: (1) recategorize transactions marked as “non-reimbursable” as “reimbursable” transactions; (2) change the pre-assigned account for a particular transaction to an alternate account; or (3) allocate portions of a particular transaction two or more different reimbursable accounts. For example, if the reimbursement system associates a first payment source with a particular transaction according to the specified plan parameters, the employee, through the graphical user interface, can reassociate the transaction with a second payment source or reclassify the transaction as “personal” or non-reimbursable. If the transaction is associated with a second payment source, the transaction data is rerouted through the reimbursement system to determine if the transaction meets the plan parameters for the second payment source. If the parameters are satisfied, the reimbursement amount is deducted from the second account. If the employee designates the transaction as personal or non-reimbursable, the system does not reimburse the employee for the transaction.
In another embodiment, the graphical user interface allows the employee to allocate portions of a transaction amount to one or more billing numbers or accounts associated with the payment source from which the transaction amount has been, or will be, reimbursed. For example, in one embodiment of the invention, the system's graphical user interface allows the employee to associate portions of particular transactions with one or more internal billing numbers. This association does not affect the responsibility of the employer (or other payment source) to reimburse the employee for the transaction, but allows the employee to assist the employer in accounting for the expense associated with the transaction internally. For example, if an employee travels to conduct business on behalf of a two or more different clients, the employee can use the interface to indicate that the related travel expenses should be split equally between the clients, which allows the employer to bill the clients appropriately for the travel expenses.
The account history screen shown in
Furthermore, in a particular embodiment of the invention, the system is configured to display information indicating which of one or more accounts were used to pay the portion of a particular claim for which the patient was responsible. For example, in the example shown in
Conclusion
Many modifications and other embodiments of the invention will come to mind to one skilled in the art to which this invention pertains having the benefit of the teachings presented in the foregoing descriptions and the associated drawings. Therefore, it is to be understood that the invention is not to be limited to the specific embodiments disclosed and that modifications and other embodiments are intended to be included within the scope of the appended exemplary concepts. Although specific terms are employed herein, they are used in a generic and descriptive sense only and not for the purposes of limitation.
This application claims priority from U.S. provisional patent application No. 60/516,648 entitled “System and Method for Providing a Credit Card with Back-End Payment Filtering,” which was filed on Oct. 30, 2003 and which is hereby incorporated by reference.
| Number | Date | Country | |
|---|---|---|---|
| 60516648 | Oct 2003 | US |
