Abstract: Various embodiments of the present invention provide systems and methods for automatically substantiating claims for health care reimbursement account plans, such as a self-funded flexible spending account (FSA), an employer-funded health care savings account (HSA), or a health care reimbursement account (HRA) over a non banking network. In particular, in various embodiments, a claims processing system is configured for receiving a claim for a health care related expense over a non-banking communications network from a health care provider and processing the claim to determine if the health care reimbursement plan account is eligible, if the balance of the account is greater than or equal to the amount of payment requested, and if the claim is sufficiently substantiated.

Abstract: Systems, and methods for reimbursing prescription fulfillment that includes identifying a drug associated with a claim submitted by a pharmacy for reimbursement by a payer (e.g., insurance carrier) and identifying a change in a manufacturer set price associated with the drug. The invention includes monitoring reimbursed claims received from at least one payer, where one of the reimbursed claims received from the payer is associated with the drug and determining if the payer has updated its internal pricing value associated with the drug. The invention further includes generating a report that includes the payer's updated internal pricing value associated with the drug, and/or creating and submitting a reversal transaction to the at least one payer followed by a resubmission of the original claim, where the resubmitted claim value is based on the payer's updated internal pricing value associated with the drug.

Abstract: Various embodiments of the present invention provide systems and methods for automatically substantiating claims for health care reimbursement account plans, such as a self-funded flexible spending account (FSA), an employer-funded health care savings account (HSA), or a health care reimbursement account (HRA) over a non banking network. In particular, in various embodiments, a claims processing system is configured for receiving a claim for a health care related expense over a non-banking communications network from a health care provider and processing the claim to determine if the health care reimbursement plan account is eligible, if the balance of the account is greater than or equal to the amount of payment requested, and if the claim is sufficiently substantiated.

Abstract: Systems, and methods for reimbursing prescription fulfillment that includes identifying a drug associated with a claim submitted by a pharmacy for reimbursement by a payer (e.g., insurance carrier) and identifying a change in a manufacturer set price associated with the drug. The invention includes monitoring reimbursed claims received from at least one payer, where one of the reimbursed claims received from the payer is associated with the drug and determining if the payer has updated its internal pricing value associated with the drug. The invention further includes generating a report that includes the payer's updated internal pricing value associated with the drug, and/or creating and submitting a reversal transaction to the at least one payer followed by a resubmission of the original claim, where the resubmitted claim value is based on the payer's updated internal pricing value associated with the drug.