Patent ID: 7917378

Claim:
A system for processing claim data related to provision of healthcare to a patient, comprising: a claim data collator for collating data related to a claim for a particular patient for submission to a payer; a source of rules for use in processing collated claim data; a pre-processor for submitting said collated claim data for automatic trial adjudication by a healthcare provider to determine expected adjudication results including expected reimbursement prior to submission for adjudication by a payer using said rules to validate said collated claim data is in condition for processing to initiate generation of payment; a claim processor, for submitting said collated claim data to said payer for adjudication by said payer, in response to successful validation by said pre-processor; and a rule creation processor for automatically creating said rules for use in processing collated claim data in response to previously identified claim data deficiencies wherein said pre-processor re-submits amended collated claim data for processing using said rules to validate said collated claim data is in condition for processing to initiate generation of payment, said amended collated claim data being received in response to unsuccessful validation using said rules.