Patent ID: 8126738

Claim:
A system for determining the appropriateness of service provider claims for payment, comprising: a scheduling module configured to schedule appointments in a computer for patients with service providers based on requests for services, wherein the scheduling module is further configured to generate appointment information corresponding to each of the scheduled appointments; a claim intake module configured to receive claims from the service providers for payment of charges associated with services rendered by the service providers to the patients, wherein the claim intake module is further configured to capture service information in a computer corresponding to each of the received claims; and an adjudication module configured to automatically identify in a computer candidate appointments that correspond to a particular received claim based on a degree of similarity between the service information associated with the particular received claim and the appointment information associated with the scheduled appointments, wherein the adjudication module is further configured to present the particular received claim for payment when at least one of the candidate appointments corresponds to the particular received claim and flag in a computer the particular received claim for resolution when none of the candidate appointments corresponds to the particular received claim.