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Insurance Abstract
A system that facilitates verifying insurance coverage of an insured
includes a radio frequency identification (RFID) card, a card reader
system, and an insurance system. The radio frequency identification
card is coupled to a patient and is capable of transmitting card
data. The card reader system receives the card data from the RFID
card and transmits the card data via a communication platform. The
insurance system receives the card data from the card reader system
via the communication platform and determines whether the insured
has insurance coverage based on the card data. The card reader system
further transmits data on the type of service provided to the insured
to the insurance system, which verifies whether the insured received
service from a provider or the provider provided service to the
insured based on the received service data from the card reader
system.
Insurance Claims
1. A system that facilitates verifying insurance coverage of an
insured, the system comprising: a radio frequency identification
(RFID) card that is coupled to a patient and is capable of transmitting
card data; and a card reader system that receives the card data
from the RFID card and transmits the card data via a communication
platform; and an insurance system that receives the card data from
the card reader system via the communication platform and determines
whether the insured has insurance coverage based on the card data.
2. The system of claim 1, wherein the RFID card is passive that
is triggered by the card reader system to transmit the card data.
3. The system of claim 1, wherein the RFID card is active that
transmits card data.
4. The system of claim 1, wherein the RFID card comprises: a computing
device that stores card data and prescription data; a transceiver
that is electrically coupled to the computing device, the transceiver
being capable of receiving data from the computing device and converting
the data from digital to analog; and an antenna that is electrically
coupled to the transceiver, the antenna being capable of transmitting
data from the computing device to the card reader system and receiving
data from the card reader system, wherein the transceiver receives
the data from the card reader system via the antenna, converts the
data from analog to digital, and sends the data to the computing
device.
5. The system of claim 4, wherein the RFID card comprises a housing
that houses the antenna, transceiver, and computing device, wherein
the outside surface of the housing includes one of a picture of
the insured; the name of the insured, the insured insurance identification
number, the insured insurance policy number, effective date, and
the type of insurance coverage.
6. The system of claim 1, wherein the card data contains one of
the name of the insured, the insured insurance identification number,
the insured insurance policy number, effective date, and the type
of insurance coverage.
7. The system of claim 1, wherein the card reader system comprises:
a computing device that stores card data and prescription data;
a transceiver that is electrically coupled to the computing device,
the transceiver being capable of receiving data from the computing
device and converting the data from digital to analog; and an antenna
that is electrically coupled to the transceiver, wherein the transceiver
receives the data from the card reader system via the antenna, converts
the data from analog to digital, and sends the data to the computing
device, the antenna being capable of transmitting and receiving
data from the computing device to and from the insurance system
and RFID card.
8. The system of claim 1, wherein the card reader system is located
in a first location, the card reader system being capable of associating
the card data to one of a provider, time, and date, and transmitting
the card data and associated data to the insurance system.
9. The system of claim 8, wherein the first location is one of
a medical clinic and a drugstore.
10. The system of claim 1, wherein the insurance system tracks
the number of times the insured uses the insurance coverage based
on the data received from the RFID card.
11. The system of claim 1, wherein the insurance system is located
in a second location, the insurance system being capable of associating
the card data to one of a time, and date when the insurance system
received the card data.
12. The system of claim 1, wherein the insurance system transmits
signal that the insured has or has no insurance coverage for medical
service based on the card data.
13. The system of claim 12, wherein the card reader system receives
the signal that the insured has or has no insurance coverage for
medical service and displays the signal on a display device of the
card reader system.
14. The system of claim 1, where the insurance system transmits
updated signal to RFID card via communication platform.
15. The system of claim 1, wherein the card reader system transmits
an activating signal to the RFID card instructing the RFID card
to transmit the card data.
16. The system of claim 1, wherein the communication platform is
one of bi-directional satellite communication, Internet protocol
communication, cellular communication, public switched telephone
network, and short message network communication.
17. The system of claim 1, wherein the card reader system transmits
data on the type of service provided to the insured to the insurance
system.
18. The system of claim 17, wherein the insurance system verifies
whether the insured received service from a provider or the provider
provided service to the insured based on the received service data
from the card reader system.
19. A insurance system that facilitates verifying insurance coverage
of an insured, the insurance system comprising: a processing device;
and a memory having an operating system and an insurance manager,
the processing device interacting with the memory to facilitate
the operating system in controlling the execution of at least the
insurance manager, wherein the insurance manager stored in a computer-readable
medium, the manager comprising: logic configured to receive data
from a card reader system and; logic configured to determine whether
the insured is authorized for insurance coverage based on the card
data from an RFID card.
20. The insurance system of claim 19, wherein the card data contains
one of the name of the insured, the insured insurance identification
number, the insured insurance policy number, and the type of insurance
coverage.
21. The insurance system of claim 19, wherein the insurance manager
further comprises logic configured to track the number of times
the insured uses the insurance coverage based on the data received
from the RFID card.
22. The insurance system of claim 19, wherein the insurance manager
further comprises logic configured to associate the card data to
one of a time, and date when the insurance system received the card
data.
23. The insurance system of claim 19, wherein the insurance manager
further comprises logic configured to transmit signal that the insured
has or has no insurance coverage for medical service based on the
card data.
24. The insurance system of claim 19, wherein the insurance manager
receives data on the type of service provided to the insured from
the card reader system.
25. The insurance system of claim 24, wherein the insurance manager
verifies whether the insured received service from a provider or
the provider provided service to the insured based on the received
service data from the card reader system.
26. A card reader system that facilitates verifying insurance coverage
of an insured, the card reader system comprising: a processing device;
and a memory having an operating system and a card reader manager,
the processing device interacting with the memory to facilitate
the operating system in controlling the execution of at least the
card reader manager, wherein the card reader manager stored in a
computer-readable medium, the manager comprising: logic configured
to receive card data from a radio frequency identification (RFID)
card; logic configured to transmit the card data to an insurance
system via a communication platform; logic configured to receive
a signal from the insurance system via the communication platform
that the insured has or has no insurance coverage for medical service
based on the card data; and logic configured to display the signal
from the insurance system on a display device.
27. The card reader system of claim 26, wherein the card data contains
one of the name of the insured, the insured insurance identification
number, the insured insurance policy number, and the type of insurance
coverage.
28. The card reader system of claim 26, wherein the card reader
manager further comprises logic configured to associate the card
data to one of a provider, time, and date, and transmitting the
card data and associated data to the insurance system.
29. The card reader system of claim 26, wherein the card reader
manager further comprises logic configured to transmit an activating
signal to the RFID card instructing the RFID card to transmit the
card data
30. The card reader system of claim 26, wherein the card reader
manager further transmits data on the type of service provided to
the insured to the insurance system that verifies whether the insured
received service from a provider or the provider provided service
to the insured based on the received service data from the card
reader system.
31. A method for verifying insurance coverage of a insured, the
method comprising: activating radio frequency identification (RFID)
card; transmitting card data from the RFID card; receiving the card
data via a card reader system; transmitting the card data to an
insurance system via a communication platform; and determining whether
the insured is authorized for insurance coverage based on the card
data.
32. The method of claim 31, further comprising associating the
card data to one of a provider, time, date, and room by the card
reader system.
33. The method of claim 31, further comprising transmitting an
activating signal to the RFID card that instructs the RFID card
to transmit the card data.
34. The method of claim 31, further comprising tracking the number
of times the insured uses the insurance coverage based on the card
data.
35. The method of claim 31, further comprising associating the
card data to one of a time, and date when the insurance system received
the card data.
36. The method of claim 31, further comprising transmitting signal
that the insured has or does not have insurance coverage for medical
service based on the card data.
37. The method of claim 31, further comprising receiving the signal
that the insured has or does not have insurance coverage for medical
service based on the card data and displaying the signal on a display
device of a card reader system.
38. The method of claim 31, further comprising receiving data on
the type of service provided to the insured.
39. The method of claim 38, further comprising verifying whether
the insured received service from a provider or the provider provided
service to the insured based on the received service data from the
card reader system.
Insurance Description
TECHNICAL FIELD
[0001] The present invention relates to the insurance industry,
and more particularly, the embodiments relate to systems, apparatuses,
and methods for verifying an insured has insurance coverage, and
whether the insured has received service from a provider or whether
the provider has provided the service to the insured.
BACKGROUND OF THE DISCLOSURE
[0002] There are a large number of frauds committed in the insurance
industry. In one scenario, a provider prescribes a medication to
an insured. The prescription is written on paper and the insured
makes copies of it. The fraudulent insured takes the copied paper
prescription to different drugstores and obtains several amounts
of prescribed medications. In another scenario, an insured goes
to several different clinics and obtains several paper prescriptions.
The fraudulent insured now has several legitimate prescriptions
and can obtain the prescribed medication in several different drugstores.
In yet another scenario, fraudulent providers can claim that an
insured has visited their clinic or drugstore when, in fact, the
insured has never visited the clinic or drugstore.
[0003] From the above, it can be appreciated that it would be desirable
to have a system, apparatus, and method for verifying whether an
insured has insurance coverage, and whether the insured has received
service from a provider or whether the provider has provided the
service to the insured.
SUMMARY OF THE DISCLOSURE
[0004] Disclosed are systems, apparatuses, and methods for verifying
whether an insured has insurance coverage, and whether the insured
has received service from a provider or whether the provider has
provided the service to the insured. In one example, an insurance
company issues a radio frequency identification (RFID) card to an
insured. The RFID card contains insurance information on the insured
and can transmit the information wirelessly. For instance, the insured
is experiencing flu-like symptoms and decides to visit a medical
clinic. When the insured visits the medical clinic, the insured
gives the RFID card to an administrator, which activates the RFID
card to transmit card data using a card reader system. The card
data includes, but is not limited to, an insurance company's name,
the subscriber's name, group name, group identification number,
member identification number, member name, the coverage type, the
effective date, the office visit co-pay, the emergency co-pay, the
pharmacy co-pay, the type of medication, the amount of dosage, the
number of medication, the name of medication, the number of refills,
and the frequency of taking the medication.
[0005] The card reader system in the medical clinic receives the
card data from the RFID card and transmits the card data to an insurance
system of an insurance provider. The insurance system verifies whether
the insured has insurance coverage based on the received card data
and transmits the verification data to the card reader system in
the medical clinic. The card reader system receives the verification
data and informs the administrator whether the insured has insurance
coverage. If the insured has no insurance coverage, the insured
may be denied any service. If the insured has insurance coverage,
the insured is provided service in the medical clinic. The service
for flu-like symptoms can include a blood test, a urine test, a
diagnosis of the illness, and a recommended medication.
[0006] The provider can transmit data on the services provided
to the insured to the RFID card using a personal digital assistant
(PDA) device. In an alternative embodiment, the provider can enter
the service data into the card reader system. In the case of a system
using the PDA, when the insured checks out of the medical clinic,
the card reader system receives the card data from the RFID card
and the service data and transmits the card and service data to
the insurance system of the insurance company. In the case of a
system without the PDA, when the insured checks out of the medical
clinic, the card reader system receives the card data from the RFID
card to associate the card data to the service data stored in the
card reader system and transmits the card and service data to the
insurance system of the insurance company. The insurance system
receives the card and service data from the card reader system in
the medical clinic and stores the card and service data in memory
that the insured has received services from the medical clinic.
This enables the system to ensure that the insured actually received
service from the medical clinic or to ensure that the medical clinic
actually provided service to the insured.
[0007] The insurance system determines whether to update card data
in the RFID card. If the card data needs to be updated, the insurance
system transmits updated card data to the card reader system via
the communication platform. If the insurance system makes a determination
not to update the card data in the RFID card, the insurance system
communicates this information to the card reader system. The card
reader system then determines whether to update the data in the
RFID card based on the updated card data received from the insurance
system. The updated card data can include the insurance information
on the insured and information on the prescribed medication. In
an alternative embodiment, the card reader system can determine
whether to update the card data in the RFID card based on the information
from the provider inputted into the card reader system. The information
can include information on the prescribed medication. The card reader
system transmits the updated card data from the insurance system
and/or information from the provider to the RFID card. The RFID
card can confirm the updated data with the insurance system via
the card reader system and the communication platform before the
RFID card stores the updated data into memory.
[0008] To obtain the prescribed medication, the insured goes to
a drugstore and a card reader system in the drugstore activates
the RFID card and receives card data from the RFID card. The card
reader system in the drugstore communicates the card data to the
insurance system via the communication platform. The insurance system
determines whether the insured has insurance coverage. If the insured
has no insurance coverage, the insured may be denied any service.
If the insured has insurance coverage, the insured is provided service
in the drugstore and the medication is distributed.
[0009] A pharmacist enters data on the services provided to the
insured into the card reader system that the insured received the
prescribed medication. When the insured checks out of the drugstore,
the card reader system receives the card data from the RFID card
to associate the card data to service data and transmits the card
and service data to the insurance system of the insurance company.
The insurance system receives the service data from the card reader
system in the drugstore and stores the service data in memory that
the insured received medication from the drugstore. The insurance
system can determine whether to update card data in the RFED card,
e.g., the remaining number of refills or that the medication has
already been obtained.
[0010] If the card data needs to be updated, the insurance system
transmits updated card data to the card reader system via the communication
platform. The card reader system receives the updated card data
from the insurance system. If the insurance system determines not
to update the card data in the RFID card, the insurance system communicates
this information to the card reader system. In an alternative embodiment,
the card reader system can determine whether to update the card
data in the RFID card based on the information from the provider
inputted into the card reader system. In both embodiments, the card
reader system transmits the updated card data from the insurance
system and/or from the provider to the RFID card. This enables the
system to ensure that an insured actually received medication from
the drugstore or to ensure that the drugstore actually provided
medication to the insured.
BRIEF DESCRIPTION OF THE DRAWINGS
[0011] The disclosed systems, apparatuses, and methods can be better
understood with reference to the following drawings. The components
in the drawings are not necessarily to scale.
[0012] FIG. 1 is a perspective view of an embodiment of a system
that verifies whether an insured has insurance coverage, and whether
the insured received service from a provider or whether the provider
provided the service to the insured.
[0013] FIG. 2 is a schematic view of an embodiment of the system
shown in FIG. 1.
[0014] FIG. 3 is a schematic view of an embodiment of the system
shown in FIG. 1.
[0015] FIG. 4 is a schematic view of an embodiment of the system
shown in FIG. 1.
[0016] FIG. 5 is a block diagram of an embodiment of an RFID card
of the system shown in FIG. 1.
[0017] FIG. 6 is a view of an embodiment of the outside surface
of the RFID card shown in FIG. 5.
[0018] FIG. 7 is a block diagram of an embodiment of a card reader
system shown in FIG. 1.
[0019] FIG. 8 is a block diagram of an embodiment of a computing
device of the RFID card shown in FIG. 5.
[0020] FIG. 9 is a block diagram of an embodiment of a computing
device of the card reader system shown in FIG. 7.
[0021] FIG. 10 is a block diagram of an embodiment of an insurance
system shown in FIG. 1.
[0022] FIGS. 11A-B are flow diagrams that illustrate an embodiment
of operation of the system shown in FIG. 1 that verifies whether
an insured has insurance coverage, and whether the insured received
service from a provider or whether the provider provided the service
to the insured.
[0023] FIG. 12 is a flow diagram that illustrates an embodiment
of operation of a RF card manager of a RFID card shown in FIG. 8.
[0024] FIG. 13 is a flow diagram that illustrates an embodiment
of operation of a card reader manager of a card reader system shown
in FIG. 9.
[0025] FIG. 14 is a flow diagram that illustrates an embodiment
of operation of an insurance manager of an insurance system shown
in FIG. 10.
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT
[0026] Disclosed herein are systems, apparatuses, and methods to
which an insured can be verified whether the insured has insurance
coverage, and whether the insured received service from a provider
or whether the provider provided the service to the insured. In
particular, the insured is coupled with a radio frequency identification
card, which transmits card data to a card reader system, preferably
located in a drugstore or a medical clinic. The card reader system
receives the card data and transmits the card data to an insurance
system via a communication platform. The insurance system determines
whether the insured is authorized for insurance coverage based on
the card data. When the insured checks out of the drugstore and/or
medical clinic, the card reader system transmits service data to
the insurance system, which verifies that the insured received service
from the drugstore and/or medical clinic.
[0027] Card data is information that enables the insurance system
to verify whether an insured has insurance coverage, and facilitate
verifying whether the insured has received service from a provider
or whether the provider has provided the service to the insured.
For example, the card data can include, but is not limited to, insured
name, place of residence, data of birth, coverage type, effective
date, member identification number, group identification number,
prescribed medication from a medical provider, number of refills
for the medication, instructions on taking the medication, the amount
of dosage, the frequency of taking the medication, etc. Service
data is information that pertains to the type of service that a
medical provider has provided to the insured. For example, the service
data can include, but is not limited to, a blood test, a urine test,
physical check for cold, physical check for flu, medication distribution,
etc.
[0028] Example systems are first discussed with reference to the
figures. Although the systems are described in detail, they are
provided for purposes of illustration only and various modifications
are feasible. After the exemplary systems have been described, examples
of operation of the systems are provided to explain the manner in
which the insured can be verified for insurance coverage.
[0029] Referring now in more detail to the figures in which like
reference numerals identify corresponding parts, FIG. 1 is a perspective
view of an embodiment of a system that verifies whether an insured
has insurance coverage, and whether the insured received service
from a provider or whether the provider provided the service to
the insured. The system 1 includes one or more radio frequency identification
(RFID) cards 3, one or more personal digital assistant devices 8,
one or more card reader systems 6, communication platform 9, and
one or more insurance systems 11. An insured is coupled with an
RFID card 3, and drugstore 5 and medical clinic 7 are coupled with
card reader systems 6A-B. The PDA 8 can transmit data on the service
provided to the insured to the RFID card 3. The RFID card 3 communicates
with the card reader system 6, which communicates with the insurance
system 11 via the communication platform 9. The RFID card 3 can
communicate with the insurance system via the card reader system
6 and communication platform 9.
[0030] FIG. 2 is a schematic view of an embodiment of the system
shown in FIG. 1. The system 1 includes RFID cards 3A-B, drugstore
5 that contains card reader 6A, medical clinic 7 that contains card
reader system 6B, a bi-directional communication satellite 15, satellite
remote station 17, an insurance company 13 that contains an insurance
system 11A, and a government 14 that contains an insurance system
11B. When the insured enters a drugstore 5 and/or medical clinic
7, the card reader system 6 can activate the RFID card 3 to transmit
card data. In an alternative embodiment, the RFID card 3 can continuously
transmit card data at a predetermined interval, e.g., every 5 seconds.
[0031] For purposes of illustration only, the insured that is coupled
to the RFID card 3A has insurance coverage with insurance company
13 and the insured that is coupled to RFID card 3B has insurance
coverage with the government 14. As shown in FIG. 2, the RFID card
3A transmits data to the card reader system 6A of the drugstore
5. The card reader system 6A not only receives card data but also
input from a medical provider on the type of service that the insured
has received in a drugstore 5. The card reader system 6A transmits
the card data and the service input to insurance system 11A of insurance
company 13 via the bi-directional communication satellite 15 and
satellite remote station 17.
[0032] The RFID card 3B transmits to the card reader system 6B
of the medical clinic 7 and a medical provider inputs a type of
service that an insured has received into the card reader system
6B. The card reader system 6B transmits the card data and the service
input to the insurance system 11B of the government 14 via bi-directional
communication satellite 15 and satellite remote station 17. The
card data from the RFID card 3 and the service input from the provider
facilitates the insurance system 11 to verify whether the insured
has insurance coverage and whether the insured received service
from the drugstore 5 and/or medical clinic 7.
[0033] It should be noted that the card reader systems 6A-B can
receive data both from the RFID cards 3A-B and transmit the card
data to either insurance system 11A of insurance company 13 or insurance
system 11B of the government 14 depending on the card data. For
example, if the insured that is coupled to RFID card 3A is insured
with insurance company 13, the card data from the RFID card 3A contains
the address code of the insurance company that will enable the card
reader system 6B of the medical clinic 7 to transmit the card data
to the insurance system 11A of the insurance company 13 via bi-directional
communication satellite 15 and satellite remote station 17.
[0034] It should also be noted that the card data in the RFID card
3 can be updated by the card reader system 6. For example, the medical
provider can prescribe medication to the insured. The medical provider
inputs the information on the medication into the card reader system
6, which transmits the medication information to the RFID card 3.
The information for the prescribed medication can include, but is
not limited to, the name of the medication, the dosage of the medication,
the number of medication being distributed, the number of refills,
the type of medication, etc. The insured takes the RFID card 3 to
the drugstore 5 and obtains the prescribed medication from a pharmacist
using the RFID card 3. The card reader system 6 can transmit the
information on the prescribed medication to the insurance system
11. The information for the prescribed medication enables the insurance
system 11 to verify whether the insured has insurance coverage for
the medication, whether the insured is authorized to receive the
medication by a provider, and whether the insured has received the
medication from a pharmacist.
[0035] In another example, the card reader system 6 can receive
data from the insurance system 11 and update the RFID card 3 with
the data. The data from the insurance system 11 that updates the
card data in the RFID card 3 can include insurance information such
as, effective date, type of insurance coverage, change the name
of the insured, prescribed medication, etc., and medication information
as mentioned above.
[0036] FIG. 3 is a schematic view of an embodiment of a system
shown in FIG. 1. FIG. 3 illustrates one embodiment of the communication
platform 9 to facilitate communications between the card reader
systems 6A-B and insurance systems 11A-B and between RFID cards
3A-B and insurance systems 11A-B using radio tower 19, cellular
carrier 21, data line 23, Internet 25, local area networks 27A-B,
and proxy servers 29A-B. FIG. 4 is a schematic view of an embodiment
of the system shown in FIG. 1. FIG. 4 illustrates one embodiment
of the communication platform 9 to facilitate communication between
the card reader systems 6A-B and insurance systems 11A-B using a
public switch telephone network 35.
[0037] FIG. 5 is a block diagram of an embodiment of an RFID card
shown in FIG. 1. The RFID card 3 includes an antenna 37, transceiver
39, and computing device 41. The antenna 37 receives and transmits
data from and to a card reader system 6. The antenna 37 is electrically
coupled to transceiver 39, which is electrically coupled to computing
device 41. The transceiver 39 receives data from the antenna 37
and converts the data from analog to digital format. For example,
the card reader system 6 can transmit an activation signal to the
RFID card 3 to transmit card data. The antenna 37 receives the activation
signal and sends it to the transceiver 39, which converts the signal
from analog to digital format. The transceiver 39 sends the digital
activation signal to the computing device, which enables the RFID
card 3 to transmit card data based on the activation signal.
[0038] The computing device 41 communicates to the card reader
system 6 via the antenna 37 and transceiver 39. For example, after
the computing device 41 receives the activation signal from the
card reader system 6, the computing device 41 sends card data to
the transceiver 39. The transceiver 37 converts the card data from
digital to analog format. The transceiver 37 sends the analog card
data to the antenna 37, which transmits the analog card data to
the card reader system 6. The card data enables the system 1 to
verify whether the insured has insurance coverage, and whether the
insured received service from a provider or the provider provided
service to the insured. It should be noted that the computing device
41 can communicate with the insurance system 11 via the card reader
system 6 and the communication platform 9.
[0039] FIG. 6 is a view of the outside surface of the RFID card
shown in FIG. 5. The outer surface of the RFID card 3 can contain,
but is not limited to, a picture of the insured 30, the insurance
company name 32, the subscriber name 34, the group name 36, the
group ID 38, member ID 40, member name 42, coverage type 44, effective
date 46, office visit co-pay 48, emergency co-pay 50, and pharmacy
co-pay 52. It should be noted that the card data contained in memory
of the RFID card 3 can contain the information that is on the outer
surface of the RFID 3 as explained in relation to FIG. 6.
[0040] FIG. 7 is a block diagram of an embodiment of the card reader
system 6 shown in FIG. 2. The card reader system 6 includes a tag
antenna 43, system antenna 45, transceiver 47, computing device
49, and input/output (I/O) port 51. The tag antenna 43 and system
antenna 45 are electrically coupled to the transceiver 47, which
is electrically coupled to the computing device 49. The tag antenna
43 of the card reader system 6 receives and transmits data from
and to the RFID card 3. Similar to the transceiver 39 of the RFID
card 3, the transceiver 47 can convert data from the antennas 43,
45 from analog to digital format, and vice versa from data received
from the computing device 49. The computing device 49 is electrically
coupled to the I/O port 51.
[0041] The computing device 49 communicates the card data from
the RFID card 3 to the insurance system 11 via the system antenna
45 or the I/O port 51. The system antenna 45 wirelessly receives
and transmits data to and from insurance system 11 via the communication
platform 9. The computing device 49 can be electrically coupled
to a network by way of the I/O port 51 to communicate to the insurance
system 11. It should be noted that the card reader system 6 can
communicate to the insurance system 11 wirelessly or wired via system
antenna 45 and I/O port 51, respectively.
[0042] FIG. 8 is a block diagram of an embodiment of a computing
device 41 of the RFID card 3 shown in FIG. 5. As indicated in FIG.
8, the computing device 41 comprises a processing device 53, memory
55, and one or more I/O devices 63, each of which is connected to
a local interface 61. The processing device 53 can include any custom
made or commercially available processor, a central processing unit
(CPU) or an auxiliary processor among several processors associated
with the computing device 41, a semiconductor based microprocessor
(in the form of a microchip), or a macroprocessor. The memory 55
can include any one or a combination of volatile memory elements
(e.g., random access memory (RAM, such as DRAM, SRAM, etc.)) and
nonvolatile memory elements (e.g., ROM, hard drive, tape, CDROM,
etc.).
[0043] The one or more I/O devices 63 comprise components used
to facilitate connection of the computing device 41 to other devices
and therefore, for instance, comprise one or more serial, parallel,
small system interface (SCSI), universal serial bus (USB), or IEEE
1394 (e.g., Firewire.TM.) connection elements. The memory 55 normally
comprises various programs (in software and/or firmware) including
an operating system (O/S) 57 and RFID card manager 59. The O/S 57
controls the execution of programs, including the RFID card manager
59, and provides scheduling, input-output control, file and data
management, memory management, and communication control and/or
related services. The RFID card manager 59 facilitates verifying
whether an insured has insurance coverage, and whether the insured
received service from a provider or the provider provided service
to the insured. Typically, the RFID card manager 59 receives an
activation signal from a card reader system 6 and transmits card
data to a card reader system 6, which transmits the card data to
an insurance system. Operation of the RFID card manager 59 is described
in relation to FIG. 12.
[0044] FIG. 9 is a block diagram of an embodiment of a computing
device of the card reader system shown in FIG. 7. The architecture
for the computing device 49 is similar to the architecture of the
computing device 41 of the RFID card 3 described above and therefore
includes a processing device 65, and one or more I/O devices 75,
each of which is connected to a local interface 73.
[0045] The memory 67 in the card reader system 6, however, includes
a card reader manager 71 that facilitates verifying whether an insured
has insurance coverage, and whether the insured received service
from a provider or the provider provided service to the insured.
Typically, the card reader manager 71 receives card data from the
RFID card 3 and input from a provider on a type of service that
an insured has received. The card reader manager 71 transmits the
card data and service data to an insurance system 11. Operation
of the card reader manager 71 is described in relation to FIG. 13.
[0046] The architecture for the computing device 49 of the card
reader system 6 further includes one or more networking devices
77 and one or more user interface devices 74. The networking devices
77 comprise the various components used to transmit and/or receive
data over the communication platform 9, where provided. By way of
example, the networking devices 77 include a device that can communicate
both inputs and outputs, for instance, a modulator/demodulator (e.g.,
modem), a radio frequency (RF) or infrared (IR) transceiver, a telephonic
interface, a bridge, a router, as well as a network card, etc. The
one or more user interface devices 74 comprise those components
with which the user (e.g., administrator) can interact with the
card reader system 6. Where the card reader system 6 comprises a
server computer or similar device, these components can comprise
those typically used in conjunction with a PC such as a keyboard
and mouse.
[0047] FIG. 10 is a block diagram of an embodiment of an insurance
system 11 of the system shown in FIG. 1. The architecture for the
insurance system 11 is similar to the architecture of the computing
device 49 of the card reader system 6 described above and therefore
includes a processing device 79, one or more networking devices
93, one or more user interface devices 89, and one or more I/O devices
91, each of which is connected to a local interface 87.
[0048] The memory 81 in the insurance system 11, however, includes
an insurance manager 85 that facilitates verifying whether an insured
has insurance coverage, and whether the insured received service
from a provider or the provider provided service to the insured.
Typically, the insurance manager 85 receives card data and service
data from the card reader system 6. The insurance manager 85 uses
the card data and services to verify whether the insured has insurance
coverage and verify whether the insured received service from a
drugstore 5 and/or medical clinic 7. Operation of the insurance
manager 85 is described in relation to FIG. 14.
[0049] FIGS. 11A-B are flow diagrams that illustrate an embodiment
of operation of the system shown in FIG. 1 in verifying whether
an insured has insurance coverage, and whether the insured received
service from a provider or the provider provided service to the
insured. Beginning with block 95, the radio frequency identification
card is activated to transmit card data. The RFID card 3 contains
card data in memory 55 that includes, but is not limited to, an
insurance company's name, the subscriber's name, group name, group
identification number, member identification number, member name,
the coverage type, the effective date, the office visit co-pay,
the emergency co-pay, the pharmacy co-pay, the type of medication,
the amount of dosage, the number of medication, the name of medication,
the number of refills, and the frequency of taking the medication.
[0050] The RFID card 3 can receive an activation signal from a
card reader system 6 to transmit the card data. The card reader
system 6 receives the card data from the RFID card 3, as indicated
in block 97. In an alternative embodiment, the card reader system
6 can associate the card data to a provider, time, and date so that
the system 1 can track the insured being provided with service from
a provider or the provider providing service to the insured. The
card reader system 6 transmits the card data to an insurance system
11 via a communication platform 9, as indicated in block 99. For
example, in a medical clinic, the card reader system 6B receives
insurance information from the RFID card to facilitate verifying
whether the insured has insurance coverage for the visitation. A
provider may prescribe medication to the insured and can use the
card reader system 6 to transmit the prescribed medication to the
RFID card 3. In an alternative embodiment, the provider can transmit
the prescribed medication to the RFID card 3 using a PDA 8. When
the insured obtains the prescribed medication from a drugstore,
the card reader system 6A receives card data including insurance
and prescription information from the RFID card 3 to facilitate
verifying whether the insured has insurance coverage for the medication.
In an alternative embodiment, the card reader system 6 also transmits
the associated data to the insurance system 11.
[0051] The insurance system 11 receives the card data and verifies
whether the insured has insurance coverage based on the data from
the card reader system, as indicated in block 101. In the case where
the insurance system 11 receives the associated data, the insurance
system 11 tracks the insured being provided with service from a
provider or the provider providing service to the insured, e.g,
the number of times the insured received service, the number of
times the provider provided service to the insured, when the services
was received/provided, etc. The insurance system 11 transmits verification
data to the card reader system 6 via the communication platform
9, as indicated in block 103. The card reader system 6 receives
the verification data and displays the data on a display device
to a provider whether the insured has insurance coverage, as indicated
block 105. If the insured has no insurance coverage, a provider
informs the insured that he/she has no insurance coverage. If the
insured has insurance coverage, the provider provides service to
the insured.
[0052] When the insured checks out of a drugstore 5 and/or medical
clinic 7, the card reader system 6 transmits data containing the
type of service provided to the insured to the insurance system
11, as indicated in block 106. For example, the type of service
in a medical clinic can be a yearly routine checkup, a physical,
an illness, a mammogram, an emergency injury, prescribed medication,
etc. The type of service in a drugstore can be, but is not limited
to, obtaining medication and refilling a medication. For example,
the card reader system 6 in a medical clinic can transmit data on
the medication that the provider prescribed to the insured to the
insurance system 11. This enables the insurance system 11 to verify
that a provider actually prescribed the medication when the insured
requests to receive the medication from a drugstore. In an alternative
embodiment, the card reader system 6 can be required to communicate
with the RFID card 3 before transmitting the service data to the
insurance system 11 during check out. This further enables the system
to ensure that an insured actually received service from the provider
or to ensure that a provider actually provided service to an insured.
[0053] In block 107, the insurance system 11 receives the service
data from the card reader system 6 and stores the service data in
memory that the insured received service from the drugstore 5 and/or
medical clinic 7. Referring to FIG. 11B reference A, in block 108,
the insurance system 11 determines whether to update card data in
the RFID card 3. If the card data needs to be updated, the insurance
system 11 transmits updated card data to the card reader system
6 via the communication platform 9, as indicated in block 109. The
card reader system 6 receives updated card data from the insurance
system 11, as indicated in block 111. If the insurance system 11
determines not to update the card data in the RFID card 3, the insurance
system 11 communicates this information to the card reader system
6.
[0054] The card reader system, in block 113, determines whether
to update the data in the RFID card 3 based on the updated card
data received from the insurance system 11. For example, the insurance
system 11 can transmit to the RFID card 3 updated data on the name
of the insured, effective date, co-payment cost, member identification,
type of prescribed medication, number of refills for the medication,
etc. In an alternative embodiment, the card reader system 6 can
also determine whether to update the card data in the RFID card
3 based on data received from the provider entered into the card
reader system 6. For example, if the provided inputs into the card
reader system 6 that the insured is being prescribed with a particular
medication, the card reader system 6 can transmit information on
the prescribed medication to the RFID card 3.
[0055] In an alternative embodiment, the card reader system 6 can
update the RFID card 3 without receiving updated data from the insurance
system 11 to update the RFID card 3. In block 115, the card reader
system 6 transmits the updated card data from the insurance system
11 and/or from the provider to the RFID card 3, which stores the
updated data into its memory 55. The system 1 can enable the insurance
companies to speed payment to the providers because the system 1
ensures that the insured actually received service from the provider
or, in other words, the provider actually provided service to the
insured.
[0056] FIG. 12 is a flow diagram that illustrates an embodiment
of operation of the RF card manager shown in FIG. 8. Beginning with
block 117, the RF card manager 59 receives signal to activate the
RFID card 3 from the card reader system 6. In an alternative embodiment,
the RFID card manager 59 can receive service data from a PDA 8.
In block 119, the RF card manager 59 transmits card data to the
card reader system 6. In block 121, the RF card manager 59 determines
whether the RFID card 3 receives updated card data. The RF card
manager 59 can receive updated card data from the card reader system
6 and/or insurance system 11. For example, the insurance system
11 can update the card data in the RFID card 3 in relation to insurance
information, e.g., an insurance company's name, the subscriber's
name, group name, group identification number, member identification
number, member name, the coverage type, the effective date, the
office visit co-pay, the emergency co-pay, the pharmacy co-pay,
etc. The card reader system 6 can update the card data in relation
to medication prescribed to the insured, e.g., the type of medication,
the amount of dosage, the number of medication, the name of the
medication, the number of refills, the frequency of taking the medication,
etc. If the RF card manager 59 receives updated card data, the RF
card manager 59 updates data in memory of the RFID card, as indicated
in block 123.
[0057] FIG. 13 is a flow diagram that illustrates an embodiment
of operation of the card reader manager 71 shown in FIG. 9. Beginning
with block 124, the card reader manager 71 transmits an activation
signal to the RFID card 3 so the RFID card 3 transmits card data.
In block 125, the card reader manager 71 receives card data from
the RFID card 3. In an alternative embodiment, the card reader manager
71 can associate the card data to a provider, time, and date so
that the system 1 can track the insured being provided with service
from a provider or the provider providing service to the insured.
In block 126, the card reader manager 71 transmits the card data
to the insurance system 11 via communication platform 9. In an alternative
embodiment, the card reader manager 71 also transmits the associated
data to the insurance system 11.
[0058] In block 127, the card reader manager 71 receives verification
data from the insurance system 11 via the communication platform
9. In block 128, the RF reader manager 71 displays the verification
data on the display device of the card reader system, which enables
a provider to determine whether the insured has insurance cover.
If the insured has no insurance coverage, the provider informs the
insured that he/she has no insurance coverage. If the insured has
insurance coverage, the provider may provide service to the insured.
[0059] When the insured checks out of a drugstore 5 and/or medical
clinic 7, the card reader manager 71 transmits data containing the
type of service provided to the insured to the insurance system
11, as indicated in block 129. The card reader manager 71, in block
130, determines whether to update the data in the RFID card 3 based
on the updated card data received from the insurance system 11.
In an alternative embodiment, the card reader system 6 can also
determine whether to update the card data in the RFID card 3 based
on data received from the provider entered into the card reader
system 6. In block 131, the card reader manager 71 transmits the
updated card data from the insurance system 11 and/or from the provider
to the RFID card 3. For example, the card reader manager 71 can
transmit information on a prescribed medication provided by a provider
to the RFID card 3. The card reader manager 71 can transmit insurance
information on the insured from the insurance system 11 to the RFID
card 3.
[0060] FIG. 14 is a flow diagram that illustrates an embodiment
of operation of an insurance manager 85 of the insurance system
11 shown in FIG. 1. Beginning with block 135, the insurance manager
85 receives card data from the card reader system 6 via the communication
platform 9. In the case where the insurance manager 85 receives
associated data, the insurance manager 85 tracks the insured being
provided with service from a provider or the provider providing
service to the insured. In block 137, the insurance manager 85 determines
whether the insured has insurance coverage based on the received
data from the card reader system 6. If the insured does not have
insurance coverage, the insurance manager 85 transmits no-insurance
data to the card reader system 6, as indicated in block 139. If
the insured has insurance coverage, the insurance manager 85 transmits
has-insurance data to the card reader system 6, as indicated in
block 141.
[0061] In block 143, the insurance manager 85 receives the service
data from the card reader system 6 and stores the service data in
memory that the insured received service from the drugstore 5 and/or
medical clinic 7. In block 145, the insurance manager 85 determines
whether to update card data in the RFID card 3. If the card data
needs to be updated, the insurance system transmits updated card
data to the card reader system 6 via the communication platform
9, as indicated in block 147. If the insurance manager 85 determines
not to update the card data in the RFID card 3, the insurance manager
85 communicates this information to the card reader system 6, as
indicated in block 149.
[0062] It should be emphasized that the above-described embodiments
of the present invention, particularly, any "preferred"
embodiments, are merely possible examples of implementations, merely
set forth for a clear understanding of the principles of the invention.
Many variations and modifications may be made to the above-described
embodiment(s) of the invention without departing substantially from
the spirit and principles of the invention. All such modifications
and variations are intended to be included herein within the scope
of this disclosure and the present invention and protected by the
following claims.
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