System and method for enhancing and authenticating an insurance eligibility transaction

Abstract

The disclosure presents a system, method, and computer readable medium for execution on a computer processor, for authenticating and enhancing an insurance eligibility transaction, such as a 270/271 healthcare system transaction. In a particular embodiment, an insurance eligibility transaction request, such as a 270 transaction, is received/intercepted by the system prior to being received by the payor and data from one or more sources, such as a credit bureau database containing credit file data, is used to enhance, verify and correct the accuracy of data fields particular to the insurance eligibility transaction. The payor's database(s) can also be enhanced accordingly. The system also has capability to, among other things, identify fraud-related issues, charity qualification, and patient payment estimation as part of the transaction.

1 . A method for authenticating and enhancing an insurance eligibility transaction, using a processor, the method comprising:
 receiving at the processor an insurance eligibility transaction request comprising target personal information associated with an individual;   determining, using the processor, whether the target personal information matches demographic data in a personal identity database in communication with the processor; and   when the target personal information matches the demographic data, creating a verified insurance transaction eligibility request based on the insurance eligibility transaction request, using the processor, the verified insurance eligibility transaction request comprising verified personal information corresponding to the target personal information; and   transmitting the verified insurance transaction eligibility request from the processor.