CENTRALIZED EOB ARCHIVING AND ACCESS

摘要

Methods and systems provide substantiation proof of claims made against medical spending accounts. Medical-insurance adjudication explanations are received at a benefits-records system, specifying a medical-insurance claim submitted to a medical insurer and identifying an adjudication decision of the medical insurance claim. The medical-insurance adjudication explanations are stored in a common format. A request is received from an insured party to apply a payment amount to a medical spending account. The payment amount corresponds to an expense associated with a medical-insurance claim submitted to one of the medical insurers but not paid. The request is posted to a third-party administrator with information from the corresponding medical-insurance adjudication explanations.

主权项

1. A system for managing electronic records of benefit information, comprising:
a communications interface of a benefits-records system configured to establish, via a computer network, a first secure network connection with a first device of a first insurance provider; the communications interface further configured to receive, via the first secure network connection from the first device of the first insurance provider, a first electronic record comprising, in a first format, data indicating an insured party and a first medical-insurance adjudication explanation for a first service of a first patient generated by the first insurance provider; the communications interface further configured to establish, via the computer network, a second secure network connection with a second device of a second insurance provider; the communications interface further configured to receive, via the second secure network connection from the second device of the second insurance provider, a second electronic record comprising, in a second format different from the first format, data indicating the insured party and a second medical-insurance adjudication explanation for a second service of a second patient generated by the second insurance provider, the second patient different from the first patient; a processor of the benefits-records system configured to:
identify the first format of the first electronic record based on an identity of the first insurance provider;convert, using a mapping, the first electronic record in the first format into a common format for storing in a storage device of the benefits-records system configured with a data repository that maintains electronic records in the common format;identify the second format of the second electronic record based on an identity of the second insurance provider, the second format different from the first format;convert, using the mapping, the second electronic record in the second format into the common format;generate, using the converted first electronic record and the converted second electronic record, a third electronic record for a single explanation of benefits comprising, in the common format, data indicating the first medical-insurance adjudication explanation for the first service and the second medical-insurance adjudication explanation for the second service; andtransmit, via a third secure network connection established with a third device of the insured party, responsive to a request from the third device of the insured party, the third electronic record for the single explanation of benefits.