Interactive determination of adjudication status of medical claims

摘要

Claims processing systems for electronically reviewing and adjudicating medical insurance claims. The claims processing systems include a benefits system, an automated adjudication system, a payment system, and a payment tracking system. The benefits system allows patients and health care providers to access patient and benefits information online. Health care providers may electronically receive partially completed claim forms containing patient and benefit information. Health care providers complete the claim forms with proposed health care treatment information and check whether the proposed claim qualifies for automated adjudication. The health care provider may amend unqualified claims in an effort to achieve automated adjudication prior to claim submission. The claims processing system performs automated adjudication on qualified claims. The payment system initiates payment to the health care provider using electronic funds transfer. The payment tracking system allows health care providers to monitor the payment status of a claim after submission.