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DATA-DRIVEN CONCEPTS FOR PROCESSING CLAIMS

  • US 20130262150A1
  • Filed: 04/11/2012
  • Published: 10/03/2013
  • Est. Priority Date: 03/30/2012
  • Status: Abandoned Application
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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