A SYSTEM FOR PROCESSING HEALTHCARE CLAIM DATA

摘要

A claim pre-processing system employs trial adjudication to improve claim accuracy prior to claim submission to a healthcare payer institution or other entity. The system includes a claim data collator for collating claim data for submission to a payer and a source of rules for use in processing collated claim data. (303) A pre-processor submits the collated claim data in condition for processing to initiate payment.(311) A claim processor submits the collated claim data to a payer, in response to successful validation. A rules processor processes acquired claim data to identify a condition triggering application of a different set of rules for determining validity of an individual claim element. (309) The pre-processor re-submits amended collated claim data for processing using the rules to validate the collated claim data in condition for processing to initiate payment, the amended collated claim data being received in response to unsuccessful validation using the rules. (321)