Intelligent eligibility request and response

US10339271B2 · kind B2 · utility

Assignee

• Passport Health Communications, Inc. · US

Inventors

• Stuart L. Beaton · Brentwood, US
• Donavon R. Feenstra · Memphis, US

Key dates

• Filing date: Oct 4, 2013
• Grant date: Jul 2, 2019
• Expiry date: May 11, 2034

Classification

• Technology area (CPC G): Physics
• CPC primary: G16H40/20
• WIPO field: IT methods for management
• WIPO sector: Electrical engineering

Abstract

Eligibility benefit information associated with a subscriber or dependent may be requested by a provider in an eligibility request, for example, a 270 request. Embodiments may intelligently determine a most appropriate service type code (STC) for a provider's eligibility request based on their location (“where”) and on the provider type (“who”). Utilizing precision STC tables for a payer (“what”) and the identity of the “who” and “where” associated with the provider sending the request, appropriate component level (and if needed, explicit level) STCs may be submitted in an intelligent eligibility request. Accordingly, an appropriately detailed yet focused response to the request may be received.