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 for paying a healthcare-related expense via a card associated with a debit account funded by insurance benefits, the method comprising:
receiving, by an authorization server, from a payment terminal, i) a request for authorization of a transfer, initiated by a recipient of insurance settlement funds, of at least a portion of the insurance settlement funds to a provider in payment for at least one of a healthcare-related service and a healthcare-related good, ii) an identifier of the provider, and iii) at least one of: a Current Procedural Terminology (CPT) code, an International Classification of Diseases (ICD) code, a Food and Drug Administration (FDA) drug identifier, a Healthcare Common Procedure Coding System (HCPCS) code and a Centers for Medicare and Medicaid Services (CMS) expense code associated with the at least one of the healthcare-related service and the healthcare-related good;
determining, by the authorization server, whether the recipient is authorized to receive the at least one of the healthcare-related service and the healthcare-related good from the identified provider;
determining, by the authorization server, whether the at least one of the CPT code, the ICD code, the FDA drug identifier, the HCPCS code, and the CMS expense code identifies at least one of a healthcare-related service and a healthcare-related good approved for purchase by the recipient; and
transmitting, by the authorization server, to the payment terminal, an approval of the transfer of the at least a portion of the insurance settlement funds, responsive to a determination that the at least one of the CPT code, the ICD code, the FDA drug identifier, the HCPCS code, and the CMS expense code identifies the at least one of the healthcare-related service and the healthcare-related good approved for purchase by the recipient and that the recipient is authorized to receive the at least one of the healthcare-related service and the healthcare-related good from the identified provider.
2 . The method of claim 1 , wherein step (b) further comprises determining, by the authorization server, that the recipient is not authorized to receive the at least one of the healthcare-related service and the healthcare-related good from the provider.
3 . The method of claim 2 , wherein step (d) comprises transmitting, by the authorization server, to the payment terminal, a rejection of the transfer of the at least a portion of the insurance settlement funds.
4 . The method of claim 1 , wherein step (c) further comprises determining, by the authorization server, that the at least one of the healthcare-related service and the healthcare-related good is not approved for purchase by the recipient.
5 . The method of claim 4 , wherein step (d) comprises transmitting, by the authorization server, to the payment terminal, a rejection of the transfer of the at least a portion of the insurance settlement funds.
6 . A computer readable medium having instructions thereon that when executed provide a method for paying a healthcare-related expense via a card associated with a debit account funded by insurance benefits, the computer readable media comprising:
instructions to receive, by an authorization server, from a payment terminal, i) a request for authorization of a transfer, initiated by a recipient of insurance settlement funds, of at least a portion of the insurance settlement funds to a provider in payment for at least one of a healthcare-related service and a healthcare-related good, ii) an identifier of the provider, and iii) at least one of: a Current Procedural Terminology (CPT) code, an International Classification of Diseases (ICD) code, a Food and Drug Administration (FDA) drug identifier, a Healthcare Common Procedure Coding System (HCPCS) code and a Centers for Medicare and Medicaid Services (CMS) expense code associated with the at least one of the healthcare-related service and the healthcare-related good;
instructions to determine, by the authorization server, whether the recipient is authorized to receive the at least one of the healthcare-related service and the healthcare-related good from the identified provider;
instructions to determine, by the authorization server, whether the at least one of the CPT code, the ICD code, the FDA drug identifier, the HCPCS code, and the CMS expense code identifies at least one of a healthcare-related service and a healthcare-related good approved for purchase by the recipient; and
instructions to transmit, by the authorization server, to the payment terminal, an approval of the transfer of the at least a portion of the insurance settlement funds, responsive to a determination that the at least one of the CPT code, the ICD code, the FDA drug identifier, the HCPCS code, and the CMS expense code identifies at least one of a healthcare-related service and a healthcare-related good approved for purchase by the recipient and that the recipient is authorized to receive the at least one of the healthcare-related service and the healthcare-related good from the identified provider.
7 . The computer readable medium of claim 6 further comprising instructions to determine, by the authorization server, that the recipient is not authorized to receive the at least one of the healthcare-related service and the healthcare-related good from the provider.
8 . The computer readable medium of claim 7 further comprising instructions to transmit, by the authorization server, to the payment terminal, a rejection of the transfer of the at least a portion of the insurance settlement funds.
9 . The computer readable medium of claim 6 further comprising instructions to determine, by the authorization server, that the at least one of the healthcare-related service and the healthcare-related good is not approved for purchase by the recipient.
10 . The computer readable medium of claim 9 further comprising instructions to transmit, by the authorization server, to the payment terminal, a rejection of the transfer of the at least a portion of the insurance settlement funds.
11 . A system for paying a healthcare-related expense via a card associated with a debit account funded by insurance benefits, comprising:
means for receiving, by an authorization server, from a payment terminal, i) a request for authorization of a transfer, initiated by a recipient of insurance settlement funds, of at least a portion of the insurance settlement funds to a provider in payment for at least one of a healthcare-related service and a healthcare-related good, ii) an identifier of the provider, and iii) at least one of: a Current Procedural Terminology (CPT) code, an International Classification of Diseases (ICD) code, a Food and Drug Administration (FDA) drug identifier, a Healthcare Common Procedure Coding System (HCPCS) code and a Centers for Medicare and Medicaid Services (CMS) expense code associated with the at least one of the healthcare-related service and the healthcare-related good;
means for determining, by the authorization server, whether the recipient is authorized to receive the at least one of the healthcare-related service and the healthcare-related good from the identified provider;
means for determining, by the authorization server, whether the at least one of the CPT code, the ICD code, the FDA drug identifier, the HCPCS code, and the CMS expense code identifies at least one of a healthcare-related service and a healthcare-related good approved for purchase by the recipient; and
means for transmitting, by the authorization server, to the payment terminal, an approval of the transfer of the at least a portion of the insurance settlement funds, responsive to a determination that the at least one of the CPT code, the ICD code, the FDA drug identifier, the HCPCS code, and the CMS expense code identifies at least one of the healthcare-related service and the healthcare-related good approved for purchase by the recipient and that the recipient is authorized to receive the at least one of the healthcare-related service and the healthcare-related good from the identified provider.
12 - 17 . (canceled)