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Method and system for adjudicating claims in a health services environment

  • US 8,285,563 B2
  • Filed: 12/21/2011
  • Issued: 10/09/2012
  • Est. Priority Date: 04/28/2006
  • Status: Expired due to Fees
First Claim
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1. A system for determining the appropriateness of service provider claims for payment, comprising:

  • a scheduling module configured to schedule appointments with service providers;

    a claim intake module configured to receive claims from the service providers;

    an adjudication module configured to match at least one scheduled appointment with at least one received claim and present at least one received claim for payment upon matching the at least one received claim to a scheduled appointment; and

    a claims acquisition module configured to determine that at least one scheduled appointment has not been identified as corresponding to at least one received claim within a predetermined period of time.

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