Systems and methods for tracking health-related spending for validation of disability benefits claims
A method for tracking health-related spending for validation of disability benefits claims includes receiving, by a Medicare Secondary Payer statute-compliance company, from an authorization server, an identification of an approved transaction initiated by a recipient of insurance settlement funds to acquire at least one of a healthcare-related service and a healthcare-related good by a provider, the recipient authorized to receive the at least one of the healthcare-related service and the healthcare-related good from the provider. The method includes tracking, by the Medicare Secondary Payer statute-compliance company, healthcare-related expenditures by the recipient. The method includes generating, by the Medicare Secondary Payer statute-compliance company, a statement of approved transactions. The method includes transmitting, by the Medicare Secondary Payer statute-compliance company, to a disability benefit provider, the statement of approved transactions.
1. A method comprising:
determining, by a processor of a computing device, one or more approved healthcare products, wherein:
the one or more approved healthcare products comprise one or more of a healthcare-related service and a healthcare-related good,
the one or more approved healthcare products are selected from a plurality of healthcare products,
the one or more approved healthcare products are identified as being relevant to at least one of an injury and an illness associated with a recipient of insurance settlement funds, wherein the insurance settlement funds relate to an insurance claim, and
the one or more approved healthcare products are approved in accordance with a Medicare Secondary Payer statute;
identifying, by the processor, an amount of money to allocate to a settlement fund account based in part upon the one or more approved healthcare products;
receiving an original settlement amount comprising a portion of the insurance settlement funds;
establishing, by the processor, the settlement fund account, wherein the settlement fund account comprises account information, and wherein the account information comprises an account balance and the original settlement amount;
establishing, between a Medicare Secondary Payer statute-compliance server and an authorization server, a secure connection;
providing, to the authorization server, product information identifying at least one approved healthcare product of the one or more approved healthcare products, wherein the product information is provided across the secure connection;
receiving, from the authorization server, an identification of approval of a transaction,
wherein the transaction corresponds to (a) the recipient of insurance settlement funds, (b) a first approved healthcare product of the one or more approved healthcare products, and (c) a provider of the first approved healthcare product,
and wherein the identification of approval indicates that the product information identifies the first approved healthcare product, and wherein the identification of approval comprises at least three of a claimant name, a claim number, a provider identification, a medical description, a medical code, and a health insurance claim number;
updating, by the processor, a number of repetitions associated with the first approved healthcare product, wherein the first approved healthcare product comprises at least one of a prescription or a treatment;
determining, by the processor, an expense associated with the transaction;
accessing, by the processor, the account information of the settlement fund account;
deducting, by the processor, the expense from the account balance of the settlement fund account;
determining, by the processor, expenditures from the account information of the settlement fund account, wherein the expenditures comprise the expense;
determining, by the processor, a statement of approved transactions, wherein the statement of approved transactions comprises:
a plurality of approved transactions, wherein each approved transaction of the plurality of approved transactions comprises at least three of date information, treatment information, provider information, and expense information,
and the account balance;
transmitting, to a disability benefit provider, the statement of approved transactions in compliance with Medicare Secondary Payer reporting requirements; and
providing a comparison of at least the expenditures to projected expenditures for statistical data analysis, wherein statistical data analysis comprises determining expenditure actuarial behaviors by one or more of an age, sex, injury category, illness category, and occupation category.
2. The method of claim 1 , further comprising:
receiving an indication of death of the recipient;
determining, by the processor, a third party associated with the settlement fund account; and
providing an instruction, to the authorization server, to transfer a portion of the account balance to the third party.
3. The method of claim 1 , wherein the statement of approved transactions further comprises a statement from the recipient attesting to having received the original settlement amount and agreeing to use the original settlement amount for payment of the plurality of approved transactions.
4. The method of claim 1 , wherein statistical data analysis further comprises summarizing a level of risk of liability created by the recipient of insurance settlement funds.
5. The method of claim 1 , wherein the statement of approved transactions further comprises an affidavit of compliance, wherein the recipient agrees through the affidavit of compliance to accept responsibility for non-compliance.
6. The method of claim 1 , wherein the Medicare Secondary Payer statute-compliance server comprises the processor.
7. The method of claim 1 , wherein the processor comprises a plurality of processors.
8. The method of claim 7 , wherein the computing device comprises a plurality of computing devices.
9. The method of claim 1 , wherein the authorization server comprises a plurality of computing devices.
10. An apparatus comprising:
a processor;
memory storing instructions thereon that, when executed, cause the processor to:
determine one or more approved healthcare products, wherein
the one or more approved healthcare products comprise one or more of a healthcare-related service and a healthcare-related good,
the one or more approved healthcare products are selected from a plurality of healthcare products,
the one or more approved healthcare products are identified as being relevant to at least one of an injury and an illness associated with a recipient of insurance settlement funds, wherein the insurance settlement funds relate to an insurance claim, and
the one or more approved healthcare products are approved in accordance with a Medicare Secondary Payer statute;
identify an amount of money to allocate to a settlement fund account based in part upon the one or more approved healthcare products;
receive an original settlement amount comprising a portion of the insurance settlement funds;
establish the settlement fund account, wherein the settlement fund account comprises account information, and wherein the account information comprises an account balance and the original settlement amount;
establish, between a Medicare Secondary Payer statute-compliance server and an authorization server, a secure connection;
provide, to the authorization server, product information identifying at least one approved healthcare product of the one or more approved healthcare products, wherein the product information is provided across the secure connection;
receive, from the authorization server, an identification of approval of a transaction,
wherein the transaction corresponds to (a) the recipient of insurance settlement funds, (b) a first approved healthcare product of the one or more approved healthcare products, and (c) a provider of the first approved healthcare product,
and wherein the identification of approval indicates that the product information identifies the first approved healthcare product, and wherein the identification of approval comprises at least three of a claimant name, a claim number, a provider identification, a medical description, a medical code, and a health insurance claim number;
update a number of repetitions associated with the first approved healthcare product, wherein the first approved healthcare product comprises at least one of a prescription or a treatment;
determine an expense associated with the transaction;
access the account information of the settlement fund account;
deduct the expense from the account balance of the settlement fund account;
determine expenditures from the account information of the settlement fund account, wherein the expenditures comprise the expense;
determine a statement of approved transactions, wherein the statement of approved transactions comprises:
a plurality of approved transactions, wherein each approved transaction of the plurality of approved transactions comprises at least three of date information, treatment information, provider information, and expense information,
and the account balance;
transmit, to a disability benefit provider, the statement of approved transactions in compliance with Medicare Secondary Payer reporting requirements; and
provide a comparison of at least the expenditures to projected expenditures for statistical data analysis, wherein statistical data analysis comprises determining expenditure actuarial behaviors by one or more of an age, sex, injury category, illness category, and occupation category.
11. A non-transitory computer readable medium, the computer readable medium comprising instructions that, when executed, cause a processor to:
determine one or more approved healthcare products, wherein
the one or more approved healthcare products comprise one or more of a healthcare-related service and a healthcare-related good,
the one or more approved healthcare products are selected from a plurality of healthcare products,
the one or more approved healthcare products are identified as being relevant to at least one of an injury and an illness associated with a recipient of insurance settlement funds, wherein the insurance settlement funds relate to an insurance claim, and
the one or more approved healthcare products are approved in accordance with a Medicare Secondary Payer statute;
identify an amount of money to allocate to a settlement fund account based in part upon the one or more approved healthcare products;
receive an original settlement amount comprising a portion of the insurance settlement funds;
establish the settlement fund account, wherein the settlement fund account comprises account information, and wherein the account information comprises an account balance and the original settlement amount;
establish, between a Medicare Secondary Payer statute-compliance server and an authorization server, a secure connection;
provide, to the authorization server, product information identifying at least one approved healthcare product of the one or more approved healthcare products, wherein the product information is provided across the secure connection;
receive, from the authorization server, an identification of approval of a transaction,
wherein the transaction corresponds to (a) the recipient of insurance settlement funds, (b) a first approved healthcare product of the one or more approved healthcare products, and (c) a provider of the first approved healthcare product,
and wherein the identification of approval indicates that the product information identifies the first approved healthcare product, and wherein the identification of approval comprises at least three of a claimant name, a claim number, a provider identification, a medical description, a medical code, and a health insurance claim number;
update a number of repetitions associated with the first approved healthcare product, wherein the first approved healthcare product comprises at least one of a prescription or a treatment;
determine an expense associated with the transaction;
access the account information of the settlement fund account;
deduct the expense from the account balance of the settlement fund account;
determine expenditures from the account information of the settlement fund account, the expenditures comprise the expense;
determine a statement of approved transactions, wherein the statement of approved transactions comprises:
a plurality of approved transactions, wherein each approved transaction of the plurality of approved transactions comprises at least three of date information, treatment information, provider information, and expense information,
and the account balance;
transmit, to a disability benefit provider, the statement of approved transactions in compliance with Medicare Secondary Payer reporting requirements; and
provide a comparison of at least the expenditures to projected expenditures for statistical data analysis, wherein statistical data analysis comprises determining expenditure actuarial behaviors by one or more of an age, sex, injury category, illness category, and occupation category.
12. A method comprising:
determining, by a processor of a computing device, one or more approved healthcare products, wherein:
the one or more approved healthcare products comprise one or more of a healthcare-related service and a healthcare-related good,
the one or more approved healthcare products are selected from a plurality of healthcare products,
the one or more approved healthcare products are identified as being relevant to at least one of an injury and an illness associated with a recipient of insurance settlement funds, wherein the insurance settlement funds relate to an insurance claim, and
the one or more approved healthcare products are approved in accordance with a Medicare Secondary Payer statute;
identifying, by the processor, an amount of money to allocate to a settlement fund account based in part upon the one or more approved healthcare products;
receiving an original settlement amount comprising a portion of the insurance settlement funds;
establishing, by the processor, the settlement fund account, wherein the settlement fund account comprises account information, and wherein the account information comprises an account balance and the original settlement amount;
establishing, between a Medicare Secondary Payer statute-compliance server and an authorization server, a secure connection;
providing, to the authorization server, product information identifying at least one approved healthcare product of the one or more approved healthcare products, wherein the product information is provided across the secure connection;
receiving, from the authorization server, an identification of approval of a transaction,
wherein the transaction corresponds to (a) the recipient of insurance settlement funds, (b) a first approved healthcare product of the one or more approved healthcare products, and (c) a provider of the first approved healthcare product,
and wherein the identification of approval indicates that the product information identifies the first approved healthcare product, and wherein the identification of approval comprises at least three of a claimant name, a claim number, a provider identification, a medical description, a medical code, and a health insurance claim number;
updating, by the processor, a number of repetitions associated with the first approved healthcare product, wherein the first approved healthcare product comprises at least one of a prescription or a treatment;
determining, by the processor, an expense associated with the transaction;
accessing, by the processor, the account information of the settlement fund account;
deducting, by the processor, the expense from the account balance of the settlement fund account;
determining, by the processor, expenditures from the account information of the settlement fund account, wherein the expenditures comprise the expense;
determining, by the processor, a statement of approved transactions, wherein the statement of approved transactions comprises:
a plurality of approved transactions, wherein each approved transaction of the plurality of approved transactions comprises at least three of date information, treatment information, provider information, and expense information,
and the account balance;
transmitting, to a disability benefit provider, the statement of approved transactions in compliance with Medicare Secondary Payer reporting requirements;
providing a comparison of at least the expenditures to projected expenditures for statistical data analysis, wherein statistical data analysis comprises determining expenditure actuarial behaviors by one or more of an age, sex, injury category, illness category, and occupation category;
receiving an indication of death of the recipient;
determining, by the processor, a third party associated with the settlement fund account; and
providing an instruction, to the authorization server, to transfer a portion of the account balance to the third party.
13. The method of claim 12 , wherein the Medicare Secondary Payer statute-compliance server comprises the processor.
14. The method of claim 12 , wherein the processor comprises a plurality of processors.
15. The method of claim 12 , wherein the computing device comprises a plurality of computing devices.
16. An apparatus comprising:
a processor;
memory storing instructions thereon that, when executed, cause the processor to:
determine one or more approved healthcare products, wherein
the one or more approved healthcare products comprise one or more of a healthcare-related service and a healthcare-related good,
the one or more approved healthcare products are selected from a plurality of healthcare products,
the one or more approved healthcare products are identified as being relevant to at least one of an injury and an illness associated with a recipient of insurance settlement funds, wherein the insurance settlement funds relate to an insurance claim, and
the one or more approved healthcare products are approved in accordance with a Medicare Secondary Payer statute;
identify an amount of money to allocate to a settlement fund account based in part upon the one or more approved healthcare products;
receive an original settlement amount comprising a portion of the insurance settlement funds;
establish the settlement fund account, wherein the settlement fund account comprises account information, and wherein the account information comprises an account balance and the original settlement amount;
establish, between a Medicare Secondary Payer statute-compliance server and an authorization server, a secure connection;
provide, to the authorization server, product information identifying at least one approved healthcare product of the one or more approved healthcare products, wherein the product information is provided across the secure connection;
receive, from the authorization server, an identification of approval of a transaction,
wherein the transaction corresponds to (a) the recipient of insurance settlement funds, (b) a first approved healthcare product of the one or more approved healthcare products, and (c) a provider of the first approved healthcare product,
and wherein the identification of approval indicates that the product information identifies the first approved healthcare product, and wherein the identification of approval comprises at least three of a claimant name, a claim number, a provider identification, a medical description, a medical code, and a health insurance claim number;
update a number of repetitions associated with the first approved healthcare product, wherein the first approved healthcare product comprises at least one of a prescription or a treatment;
determine an expense associated with the transaction;
access the account information of the settlement fund account;
deduct the expense from the account balance of the settlement fund account;
determine expenditures from the account information of the settlement fund account, wherein the expenditures comprise the expense;
determine a statement of approved transactions, wherein the statement of approved transactions comprises:
a plurality of approved transactions, wherein each approved transaction of the plurality of approved transactions comprises at least three of date information, treatment information, provider information, and expense information,
and the account balance;
transmit, to a disability benefit provider, the statement of approved transactions in compliance with Medicare Secondary Payer reporting requirements;
provide a comparison of at least the expenditures to projected expenditures for statistical data analysis, wherein statistical data analysis comprises determining expenditure actuarial behaviors by one or more of an age, sex, injury category, illness category, and occupation category;
receive an indication of death of the recipient;
determine, by the processor, a third party associated with the settlement fund account; and
provide an instruction, to the authorization server, to transfer a portion of the account balance to the third party.
17. A non-transitory computer readable medium, the computer readable medium comprising instructions that, when executed, cause a processor to:
determine one or more approved healthcare products, wherein
the one or more approved healthcare products comprise one or more of a healthcare-related service and a healthcare-related good,
the one or more approved healthcare products are selected from a plurality of healthcare products,
the one or more approved healthcare products are identified as being relevant to at least one of an injury and an illness associated with a recipient of insurance settlement funds, wherein the insurance settlement funds relate to an insurance claim, and
the one or more approved healthcare products are approved in accordance with a Medicare Secondary Payer statute;
identify an amount of money to allocate to a settlement fund account based in part upon the one or more approved healthcare products;
receive an original settlement amount comprising a portion of the insurance settlement funds;
establish the settlement fund account, wherein the settlement fund account comprises account information, and wherein the account information comprises an account balance and the original settlement amount;
establish, between a Medicare Secondary Payer statute-compliance server and an authorization server, a secure connection;
provide, to the authorization server, product information identifying at least one approved healthcare product of the one or more approved healthcare products, wherein the product information is provided across the secure connection;
receive, from the authorization server, an identification of approval of a transaction,
wherein the transaction corresponds to (a) the recipient of insurance settlement funds, (b) a first approved healthcare product of the one or more approved healthcare products, and (c) a provider of the first approved healthcare product,
and wherein the identification of approval indicates that the product information identifies the first approved healthcare product, and wherein the identification of approval comprises at least three of a claimant name, a claim number, a provider identification, a medical description, a medical code, and a health insurance claim number;
update a number of repetitions associated with the first approved healthcare product, wherein the first approved healthcare product comprises at least one of a prescription or a treatment;
determine an expense associated with the transaction;
access the account information of the settlement fund account;
deduct the expense from the account balance of the settlement fund account;
determine expenditures from the account information of the settlement fund account, the expenditures comprise the expense;
determine a statement of approved transactions, wherein the statement of approved transactions comprises:
a plurality of approved transactions, wherein each approved transaction of the plurality of approved transactions comprises at least three of date information, treatment information, provider information, and expense information,
and the account balance;
transmit, to a disability benefit provider, the statement of approved transactions in compliance with Medicare Secondary Payer reporting requirements;
provide a comparison of at least the expenditures to projected expenditures for statistical data analysis, wherein statistical data analysis comprises determining expenditure actuarial behaviors by one or more of an age, sex, injury category, illness category, and occupation category;
receive an indication of death of the recipient;
determine, a third party associated with the settlement fund account; and
provide an instruction, to the authorization server, to transfer a portion of the account balance to the third party.