SYSTEM AND METHOD FOR PROCESSING FLEXIBLE SPENDING ACCOUNT TRANSACTIONS
A system and method are provided for processing flexible spending account transactions involving a plurality of pharmacies, a service provider, one or more pharmacy benefits managers (“PBMs”), and individuals having flexible spending accounts (“FSAs”) and stored value cards for debiting their FSAs. The service provider maintains a PBM transaction database; receives from a pharmacy an authorization request at the time of purchase; queries the PBM transaction database for a matching transaction in response to the authorization request; and authorizes payment of the patient responsible balance to be automatically debited against the respective FSA at the time of purchase.
1 . A computer implemented method for substantiating a transaction prior to authorizing the transaction, comprising the steps of:
receiving transaction data involving qualified medical expenses and/or patient responsible balances (PRBs);
receiving an authorization request to authorize payment of a qualified medical expense and/or PRB against an account associated with a customer, wherein the authorization request is associated with a transaction between a customer associated with the account and the goods or service provider; and
performing a substantiation process for the payment to the goods or service provider for the transaction prior to the authorization of the payment for the transaction, the substantiation process comprising:
querying a database to obtain transaction information associated with the customer;
matching of the transaction information from the database with the received transaction data; and
communicating authorization for payment of the qualified medical expense and/or PRB against the account after the matching the transaction information with the transaction data.