Patent ID: 8762163

Claim:
A computer-implemented method, comprising: routing, to a claims processor computer, a healthcare claim transaction received from a healthcare provider computer; receiving an adjudicated reply, from the claims processor computer, to the healthcare claim transaction; responsive to a determination that the adjudicated reply indicates that the claim transaction was paid, route the adjudicated reply indicating that the claim was paid to the healthcare provider computer; responsive to a determination that the adjudicated reply indicates that the claim transaction was not paid, further determining whether the healthcare claim transaction has not been approved as a result of a host processor error associated with the claims processor computer; responsive to a determination that the claim has not been rejected as a result of a host processing error, route the adjudicated reply indicating that the claim was not paid to the healthcare provider computer; responsive to a determination that the claim has not been approved as a result of a host processing error, perform the following steps: identifying, based at least in part on the received adjudicated reply, a host processing error associated with the claims processor computer, wherein the host processing error includes at least one of an unresponsive host error, a high bandwidth error, or an unavailable host error; further identifying a National Council for Prescription Drug Programs (NCPDP) reject code associated with the host processing error; determining that the healthcare claim transaction has not been approved as a result of the identified host processor error associated with the claims processor computer; determining that a value of an adjudication timer initiated by a pre-edit performed on the healthcare claim transaction prior to routing to the claims processor and associated with identifying the host processing error does not exceed a resubmission threshold, wherein the resubmission threshold is determined by subtracting an estimated healthcare claim processing time from an adjudication threshold; and resubmitting, based at least in part on the determination that the healthcare claim transaction has not been approved and that the value of the adjudication timer does not exceed the resubmission threshold, the healthcare claim transaction to the claims processor computer; receiving an adjudicated reply for the resubmitted healthcare claim transaction from the claims processor computer, and routing the received adjudicated reply to the healthcare provider computer, wherein the above operations are performed by one or more computers associated with a service provider.