Patent ID: 7970629
Filing Date: 2011-06-28
Classification: G06Q

Abstract:
1. A system for adapting 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 said payer organization in a claim, comprising: a data processor for parsing claim adjudication data provided by a specific payer organization in an electronic transaction message to identify data comprising, a rules processor for automatically generating a payer specific rule for use in pre-processing a claim for submission to the specific payer organization identified by said payer organization identifier, by automatic analysis of adjudication data of claims previously rejected by a payer and using data of an original claim previously submitted to the specific payer organization and corresponding to the received adjudication data and by translating data comprising said reason for rejection into a logical expression resolvable using data elements in a claim; and a rules repository storing data in a non-transitory storage medium for accumulating data representing automatically generated payer organization specific rules; and a pre-processor for applying said automatically generated payer specific rules acquired from said rules repository to a claim prior to submission of said claim to said specific payer organization.