Patent ID: 8438047

Claim:
A system for providing a claims processing environment for facilitating insurance claim adjudication, comprising: a database programmed to store insurance claim data comprising a plurality of insurance claims submitted for payment; a processor programmed to: select and retrieve insurance claims submitted for payment that have not been paid from the plurality of insurance claims in the database, wherein the claims selected and retrieved have not been paid based on a failed automatic claim adjudication and require manual revision by a user for payment of the claims to proceed; identify one or more reasons the claims failed automatic claim adjudication and require manual revision; and generate scripting data based on the identified one or more reasons, wherein the scripting data comprises instructions to facilitate and guide the user in the manual revision of the claims for payment of the claims to proceed; at least one computer user terminal configured to receive the claims requiring manual revision and the scripting data from the processor, display the claims requiring manual revision and the generated scripting data instructions, and accept manual edits to the claims from the user that are based on the scripting data instructions; a rules engine that receives the accepted manually edits entered by the user through the computer user terminal and applies one or more claim adjudication rules to automatically resolve the manual edits; and upon automatically resolving the manual edits, the processor is programmed to: generate scripting data instructing the user to enter an accept payment claim edit; and receive the accept payment edit from the user, thereby enabling payment of the claims to proceed.