Patent ID: 8756075

Claim:
A process for repricing individual provider claims comprising: receiving, at a processing system including at least one server, from a payer a first data set including first specific data from a first individual provider claim; analyzing, by the processing system including at least one server, the first data set to determine one of the following: (a) the first individual provider claim is part of an existing payment bundle; (b) the first individual provider claim triggers creation of a patient event and an associated payment bundle; (c) the first individual provider claim is neither (a) or (b); (d) the first individual provider claim should be held up to a predetermined amount of time pending receipt by the processing system of additional data or passage of the predetermined amount of time; and transmitting to the payer, by the processing system including at least one server, at least one of the following responses in accordance with the analysis: (e) the first individual provider claim is not part of an existing or associated payment bundle, pay the provider under non-payment bundle terms; (f) the first individual provider claim is part of an existing or associated payment bundle, pay the provider under one of existing or associated payment bundle terms; (g) the first individual provider claim did not contain enough information, delay payment to the provider; receiving by the processing system including at least one server, bundle type definitions and bundle-specific rules associated with each bundle type definition; formulating payment bundles using the bundle type definitions and the bundle-specific rules; and storing payment bundles in at least a first database of the processing system.