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 othe r entity. The system includes a claim data collator for collating claim data f or 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 conditi on for processing to initiate payment.(311) A claim processor submits the collated claim data to a payer, in response to successful validation. A rule s 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 collate d claim data for processing using the rules to validate the collated claim dat a in condition for processing to initiate payment, the amended collated claim data being received in response to unsuccessful validation using the rules. (321)