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Computerized system and methods for adjudicating and reimbursing for healthcare services based on quality

  • US 20060265251A1
  • Filed: 01/06/2006
  • Published: 11/23/2006
  • Est. Priority Date: 01/06/2005
  • Status: Active Grant
First Claim
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1. A method in a computing environment for adjudicating and reimbursing a care provider for services provided for a clinical event, comprising:

  • receiving a transaction including a number of clinical event details for the clinical event;

    accessing a first knowledge base comprising a number of criteria for assessing quality of care;

    selecting at least one appropriate criterion based on the clinical event details;

    performing analysis of the clinical event details against the selected at least one criterion to determine the quality of care; and

    determining a level of reimbursement based on the quality of care.

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