Data processing: financial – business practice – management – or co – Automated electrical financial or business practice or... – Health care management
Reexamination Certificate
2011-06-28
2011-06-28
Morgan, Robert (Department: 3626)
Data processing: financial, business practice, management, or co
Automated electrical financial or business practice or...
Health care management
C705S004000
Reexamination Certificate
active
07970629
ABSTRACT:
A system improves payment claims transactions by analyzing payments transactions to update payment edit rules according to information derived from the transactions. A system adapts rules used for processing claim adjudication data provided by a payer organization concerning a claim for reimbursement for provision of healthcare to a patient previously submitted to the payer organization in a claim. The system includes a data processor for parsing claim adjudication data provided by a specific payer organization in an electronic transaction message to identify data comprising, (a) a payer organization identifier and (b) a reason for rejection of a claim. A rules processor automatically generates a payer specific rule for use in pre-processing a claim for submission to the specific payer identified by the payer organization identifier by translating data comprising the reason for rejection into a logical expression resolvable using data elements in a claim. A rules repository accumulates data representing automatically generated payer specific rules for pre-processing a claim for submission to the specific payer.
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Burke Alexander J
Morgan Robert
Nguyen Tran
Siemens Medical Solutions USA , Inc.
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