Claim data processing system
First Claim
1. A system for processing claim data related to provision of healthcare to a patient, comprising:
- an interface processor for receiving claim data comprising data related to a claim for provision of healthcare to a particular patient and including a claim type identifier;
at least one repository including;
predetermined claim generation rules for use in generating a claim for submission to a payer institution, said claim generation rules being hierarchically organized to enable more frequently applied rules to be identified and applied first, and information associating particular rules to be applied with a particular claim type; and
a claim processor, for generating a claim of a particular type for submission to a particular payer institution by applying claim generation rules derived from said at least one repository in a predetermined priority in response to said received claim type identifier.
1 Assignment
0 Petitions
Accused Products
Abstract
A system for processing claim data related to provision of healthcare to a patient includes an interface processor for receiving data related to a claim for provision of healthcare to a particular patient and including a claim type identifier. At least one repository includes predetermined claim generation rules for use in generating a claim for submission to a payer institution. The claim generation rules are hierarchically organized to enable more frequently applied rules to be identified and applied first. The repository also includes information associating particular rules to be applied with a particular claim type. A claim processor generates a claim of a particular type for submission to a particular payer institution by applying claim generation rules derived from the repository in a predetermined priority in response to the received claim type identifier.
-
Citations
20 Claims
-
1. A system for processing claim data related to provision of healthcare to a patient, comprising:
-
an interface processor for receiving claim data comprising data related to a claim for provision of healthcare to a particular patient and including a claim type identifier;
at least one repository including;
predetermined claim generation rules for use in generating a claim for submission to a payer institution, said claim generation rules being hierarchically organized to enable more frequently applied rules to be identified and applied first, and information associating particular rules to be applied with a particular claim type; and
a claim processor, for generating a claim of a particular type for submission to a particular payer institution by applying claim generation rules derived from said at least one repository in a predetermined priority in response to said received claim type identifier. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17)
-
-
18. A method for processing claim data related to provision of healthcare to a patient, comprising the activities of:
-
receiving claim data comprising data related to a claim for provision of healthcare to a particular patient and including a claim type identifier;
organizing predetermined claim generation rules to enable more frequently applied rules to be identified and applied first, said claim generation rules being for use in generating a claim for submission to a payer institution;
associating particular rules to be applied with a particular claim type; and
generating a claim of a particular type for submission to a particular payer institution by applying claim generation rules in a predetermined priority based on said hierarchical organization and in response to said received claim type identifier. - View Dependent Claims (19, 20)
-
Specification