SYSTEM AND METHOD FOR OPERATING MODULES OF A CLAIMS ADJUDICATION ENGINE

摘要

A system and method for configuring an adjudication system to adjudicate a claim transaction. The system and method comprise: receiving the claim transaction containing line items describing an insured service for a recipient to be financed by a payer for the insured service; providing an adjudication engine for coordinating the adjudication processing of the received claim transaction; representing the claim transaction as a plurality of business objects coupled to a database such that the business objects are selected from a set of available business objects, the business objects coupled to the adjudication engine and configured for containing data instances of the claim transaction; and selecting a plurality of adjudication modules for coupling to the plurality of business objects, the plurality of adjudication modules selected from a set of available adjudication modules, the selected adjudication modules configured for providing business logic applied to the business objects during the adjudication processing to manipulate the data instances of the business objects; wherein the configured adjudication system adjudicates the data instances of the business objects according to the business logic of the selected adjudication modules for determining an adjudication status of the claim transaction.