Patent ID: 6343271
Filing Date: 2002-01-29
Classification: G06Q

Abstract:
In a system comprising a health care benefit component that stores patient and benefit information and allows access to stored information by a health care provider, an automated adjudication component that automatically adjudicates claims submitted for payment, an automated payment component that automatically pays adjudicated claims, a payment tracking component that tracks the status of claims submitted for automatic payment, and an access terminal associated with the health care provider, a method for submitting and adjudicating claims comprising the steps of:accessing, using the access terminal, the patient and benefit information stored by the health care benefit component such that the health care provider can ascertain patient information in preparation for submitting a claim for treatment provided to a patient; creating, using the access terminal, the claim by entering information regarding treatment provided to said patient into an electronic claim form that can be submitted for payment; testing the adjudication status of said claim, so that before said claim is submitted for adjudication, said health care provider may know whether said claim is to be manually adjudicated by an adjudicator or whether said claim is to be automatically adjudicated; transmitting said claim from the access terminal, thereby submitting said claim for adjudication; and if said claim is to be automatically adjudicated and paid automatically, then tracking the payment status of said claim using the access terminal.