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Systems And Methods For Health Insurance Claim Processing

  • US 20120029950A1
  • Filed: 07/28/2011
  • Published: 02/02/2012
  • Est. Priority Date: 07/28/2010
  • Status: Abandoned Application
First Claim
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1. A method for health insurance claim processing, comprising:

  • receiving, within a claim receiver, a claim submission from a client, the claim submission identifying a policy of the client and details of the health insurance claim;

    converting, within the claim receiver, the claim submission into a claim charge to facilitate automated processing of the health insurance claim;

    validating the claim charge against one or more validation rules to identify zero, one, or more claim validation exceptions;

    resolving the claim validation exceptions; and

    settling the claim submission based upon the claim charge if the validated claim charge and any remaining validation exceptions conform to settlement control data.

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