Patent ID: 8706532

Claim:
A computer implemented method for processing insurance claims using a set of adjudication rules to customize a plan, the method stored on a storage as a series of steps executable by a computer processor for: receiving a claim for processing having claim content including a claim date; accessing the set of adjudication rules configured for adjudicating the received claim, the set of adjudication rules structured in a plurality of containers including a primary rule container and a plurality of secondary rule containers, each of the plurality of secondary rule containers being coupled to the primary rule container by a respective corresponding container reference associated with the content of the primary rule container, the primary rule container having a list to define an execution order of the corresponding container references of each of the plurality of secondary rule containers referenced by the primary rule container, each of the plurality of secondary rule containers containing one or more adjudication rules adapted for processing the claim content of the received claim, each of the one or more adjudication rules being coupled as belonging to their respective secondary container by a respective rule reference associated with the content of the respective secondary rule container, at least one of the container reference or the rule reference having an associated rule date; comparing the associated rule date to the claim date to determine which of the one or more adjudication rules are used as an adjudication rule set included in the execution order that are appropriate to the claim content of the claim; processing the content of the received claim with the adjudication rule set by an adjudication engine processor in the execution order defined by the list of the container references in the primary rule container to provide an adjudicated result; wherein the adjudicated result of the processed claim is used to determine subsequent settlement of the received claim.