Patent ID: 8862485

Claim:
A health care billing quality assurance application system comprising: a non-transitory computer readable storage device configured to store executable programmed modules; at least one processor communicatively coupled with the non-transitory computer readable storage device configured to execute programmed modules stored therein; and one or more executable software modules that, when executed by the at least one processor, receives a first patient data record comprising a field that identifies a first payer, wherein the first patient data record is to be used to generate a first claim to be submitted to the first payer, maps data in the first patient data record to one or more fields, applies a first set of rules determined by the first payer to the one or more fields comprising first patient data record data to determine whether the first patient data record is potentially noncompliant with a standard of the first payer, and if the first patient data record is potentially noncompliant with the standard of the first payer, flags any suspect ones of the one or more fields comprising first patient data record data, and assigns the first patient data record to at least one of a plurality of reviewers for quality assurance review prior to generating and submitting the first claim to the first payer; and receives a second patient data record, different from the first patient data record, comprising a field that identifies a second payer, wherein the second patient data record is to be used to generate a second claim to be submitted to the second payer, maps data in the second patient data record to one or more fields, applies a second set of rules determined by the second payer to the one or more fields comprising second patient data record data to determine whether the second patient data record is potentially noncompliant with a standard of the second payer, wherein the standard of the second payer is different from the standard of the first payer, and if the second patient data record is potentially noncompliant with the standard of the second payer, flags any suspect ones of the one or more fields comprising second patient data record data, and assigns the second patient data record to at least one of a plurality of reviewers for quality assurance review prior to generating and submitting the second claim to the second payer.