DATA-DRIVEN CONCEPTS FOR PROCESSING CLAIMS
First Claim
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1. A method for processing a claim, the method comprising:
- processing a current claim line in accordance (a) with a first claims processing rule and (b) a first support claim line;
determining whether an entry exists in a table for the first claims processing rule, wherein the entry for the first claims processing rule indicates how to process the current claim line when the current claim line and a support claim line satisfy the requirements of the entry for the first claims processing rule;
after determining that an entry exists in the table for the first claims processing rule, determining whether the current claim line and the first support claim line satisfy the requirements of the entry for the first claims processing rule; and
after determining that the current claim line and the first support claim line satisfy the requirements of the entry for the first claims processing rule, determining how to process the current claim line based at least in part on the entry for the first claims processing rule.
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Abstract
Systems, methods, apparatus, and computer program products are provided for processing claims. In various embodiments, claims can be processed in accordance with a data-driven approach that limits changes to existing claims processing rules.
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Citations
24 Claims
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1. A method for processing a claim, the method comprising:
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processing a current claim line in accordance (a) with a first claims processing rule and (b) a first support claim line; determining whether an entry exists in a table for the first claims processing rule, wherein the entry for the first claims processing rule indicates how to process the current claim line when the current claim line and a support claim line satisfy the requirements of the entry for the first claims processing rule; after determining that an entry exists in the table for the first claims processing rule, determining whether the current claim line and the first support claim line satisfy the requirements of the entry for the first claims processing rule; and after determining that the current claim line and the first support claim line satisfy the requirements of the entry for the first claims processing rule, determining how to process the current claim line based at least in part on the entry for the first claims processing rule. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8)
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9. A computer program product for processing a claim, the computer program product comprising at least one non-transitory computer-readable storage medium having computer-readable program code portions stored therein, the computer-readable program code portions comprising:
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an executable portion configured to process a current claim line in accordance (a) with a first claims processing rule and (b) a first support claim line; an executable portion configured to determine whether an entry exists in a table for the first claims processing rule, wherein the entry for the first claims processing rule indicates how to process the current claim line when the current claim line and a support claim line satisfy the requirements of the entry for the first claims processing rule; an executable portion configured to, after determining that an entry exists in the table for the first claims processing rule, determine whether the current claim line and the first support claim line satisfy the requirements of the entry for the first claims processing rule; and an executable portion configured to, after determining that the current claim line and the first support claim line satisfy the requirements of the entry for the first claims processing rule, determine how to process the current claim line based at least in part on the entry for the first claims processing rule. - View Dependent Claims (10, 11, 12, 13, 14, 15, 16)
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17. An apparatus comprising at least one processor and at least one memory including computer program code, the at least one memory and the computer program code configured to, with the processor, cause the apparatus to at least:
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process a current claim line in accordance (a) with a first claims processing rule and (b) a first support claim line; determine whether an entry exists in a table for the first claims processing rule, wherein the entry for the first claims processing rule indicates how to process the current claim line when the current claim line and a support claim line satisfy the requirements of the entry for the first claims processing rule; after determining that an entry exists in the table for the first claims processing rule, determine whether the current claim line and the first support claim line satisfy the requirements of the entry for the first claims processing rule; and after determining that the current claim line and the first support claim line satisfy the requirements of the entry for the first claims processing rule, determine how to process the current claim line based at least in part on the entry for the first claims processing rule. - View Dependent Claims (18, 19, 20, 21, 22, 23, 24)
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Specification