Patent ID: 8364498

Claim:
A system for processing healthcare claims and remittances, the system comprising: a database containing previously received healthcare claims from a plurality of healthcare providers and previously received remittances from a plurality of payers; and an electronic portal connected to the database, the electronic portal configured to receive a healthcare claim from a healthcare provider and to split the received claim into a plurality of data elements, the data elements comprising at least a patient identifier, a healthcare provider identifier, a date of service, and an amount payable; the electronic portal further configured to determine if any necessary data is missing from the received claim and to send a missing data request to the healthcare provider; the electronic portal further configured to perform a duplicate claim edit and a third party liability edit on the received claim, wherein the third party liability edit comprises determining if one or more third party payers is responsible for paying at least a portion of the amount payable associated with the received claim, and wherein determining if the one or more third party payers is responsible for paying comprises at least one of (a) comparing an insurance carrier listed on the received claim to a stored list of insurance carriers that exclusively function as third party payers, and (b) searching the database for previously received healthcare claims corresponding to the same patient identifier as the received claim, and determining if any such previously received claims are associated with a third party payer; and the electronic portal further configured to, based on the result of the duplicate claim edit or the third party liability edit, submit the received claim to a payer.