System and method for reconciling an insurance payment with an insurance claim
First Claim
1. A method for reconciling an insurance payment to an entity, such as a pharmacy, with an insurance claim made by the entity, comprising:
- providing a claim value belonging to a set of claim values;
providing a claim identification value associated with the claim value and belonging to a set of claim identification values;
providing a payment value belonging to a set of payment values;
providing a payment identification value associated with the payment value and belonging to a set of payment identification values; and
where the payment identification value and the claim identification value correspond to each other, matching the payment value with the claim value. where the payment value and the claim value are matched, comparing the payment value and the claim value to identify at least one of an acceptably deviant payment, an underpayment, and an overpayment, and accurate payment.
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Abstract
Disclosed herein is a method for reconciling an insurance payment to an entity, such as a pharmacy, with an insurance claim made by the entity. Some embodiments of the method comprise providing a claim value belonging to a set of claim values, providing a claim identification value associated with the claim value and belonging to a set of claim identification values, providing a payment value belonging to a set of payment values, providing a payment identification value associated with the payment value and belonging to a set of payment identification values and, where the payment identification value and the claim identification value correspond to each other, matching the payment value with the claim value. Additional systems and methods are also disclosed herein.
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Citations
20 Claims
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1. A method for reconciling an insurance payment to an entity, such as a pharmacy, with an insurance claim made by the entity, comprising:
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providing a claim value belonging to a set of claim values;
providing a claim identification value associated with the claim value and belonging to a set of claim identification values;
providing a payment value belonging to a set of payment values;
providing a payment identification value associated with the payment value and belonging to a set of payment identification values; and
where the payment identification value and the claim identification value correspond to each other, matching the payment value with the claim value. where the payment value and the claim value are matched, comparing the payment value and the claim value to identify at least one of an acceptably deviant payment, an underpayment, and an overpayment, and accurate payment. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18)
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19. A method for reconciling an insurance payment to an entity, such as a pharmacy, with an insurance claim made by the entity, comprising:
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providing a claim value belonging to a set of claim values;
providing a claim identification value associated with the claim value and belonging to a set of claim identification values;
scanning a remittance document that articulates a plurality of itemized payments and a plurality of itemized identifications and associates an itemized payment with an itemized identification;
defining an association between a payment value and a payment identification value based at least in part on the association between the itemized payment and the itemized identification;
providing the payment value and the payment identification value;
where the payment identification value and the claim identification value correspond to each other, matching the payment value with the claim value;
where the payment value is unmatched with each member of the set of claim values, indicating a misdirected payment; and
where the claim value is unmatched with each member of the set of payment values, indicating a missing payment.
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20. A system for reconciling an insurance payment to an entity, such as a pharmacy, with an insurance claim made by the entity, comprising a computer-readable medium having stored thereon computer-executable instructions for performing the following:
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providing a claim value belonging to a set of claim values;
providing a claim identification value associated with the claim value and belonging to a set of claim identification values;
providing a payment value belonging to a set of payment values;
providing a payment identification value associated with the payment value and belonging to a set of payment identification values; and
where the payment identification value and the claim identification value correspond to each other, matching the payment value with the claim value.
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Specification