| 摘要 |
To take into account the various specifics of health care information available to the health plan members and health care providers in the context of estimating the members' out-of-pocket payments, embodiments of the invention are used to provide an electronic health care information system with custom interfaces and underlying processing optimized for the health plan member and health care provider contexts. Embodiments of the health care information system construct a pseudo-claim based on the information gathered via the member or provider interfaces and provide an accurate real-time estimate of the member's out-of-pocket responsibility based on adjudicating the pseudo-claim by taking into account the details of the member's health plan and current benefit levels.
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