Patent ID: 8738402

Claim:
A method of adjudicating a medical claim, the method comprising: storing a plurality of medical claims on a claim processing server accessible over the Internet by a medical service provider, each medical claim representing medical benefits and having a set of requirements; receiving over the Internet a medical claim request from the medical service provider and storing the medical claim request on the claim processing server, the medical claim request comprising a plurality of components that includes identification of a proposed medical procedure that is to be performed on a patient; setting by a computer program running on the claim processing server an initial score for at least some of the medical claims; adjusting by a computer program running on the claim processing server at least some of the initial scores in one of a positive direction or negative direction by evaluating at least some of the components of the medical claim request against at least some of the requirements for at least some of the medical claims and determining whether a component of the medical claim request matches a requirement, thereby producing a plurality of adjusted scores for at least some of the medical claims; selecting by a computer program running on the claim processing server a medical claim based on the plurality of adjusted scores; adjudicating by a computer program running on the claim processing server the medical claim request by determining acceptance or rejection of the medical claim request and a monetary value of a proposed medical procedure according to the adjusted score of the selected medical claim; transmitting by the claim processing server a notification over the Internet to the medical service provider, the notification comprising one of (a) a rejection of the proposed medical procedure, and (b) an acceptance of the proposed medical procedure with the monetary value.