CLAIMS CLINICAL CODE EDITING AND PROCEDURE MANAGEMENT TOOL

摘要

A system, method, and user interface for performing maintenance of procedure clinical edit data and associated clinical code editing rules. The system includes a health insurance company and at least one health care provider. The health insurance company includes a computer system with a graphical user interface tool for generating a plurality of health care procedure clinical code editing rules and clinical edit data, and a component for sending at least a portion of the generated plurality of health care procedure clinical code editing rules to a recipient over a data network. The health care provider includes a computer system coupled to the data network for receiving the sent plurality of health care procedure clinical code editing rules and for presenting the received plurality of clinical code editing rules for review. The health care provider also includes a means for entering a claim for one or more performed health care procedures based on review of the plurality of clinical code editing rules.