Patent ID: 8447627

Claim:
A computerized method of managing requests by a health care service provider for payment, the method including processes, performed by a computer system operated on behalf of the provider, comprising: for each claim in a set of multiple claims, generating, by the computer system operated on behalf of the provider, a first unique identifier, associated with such claim, and a second unique identifier associated with each line item of the claim; assembling, by the computer system operated on behalf of the provider, the set of multiple claims into a single electronic file of the provider for submission to a computer system operated on behalf of a payer, in a manner that such that, for each claim in the file there is provided (i) the first unique identifier, associated with such claim, in a field required by standards to be preserved during processing by a computer system operated on behalf of the payer and (ii) the second unique identifier associated with each line item of the claim, wherein the second identifier is distinct for each line item; causing electronic transmission, by the computer system operated on behalf of the provider, of the electronic file of the provider over a network to the computer system operated on behalf of the payer, wherein the transmitted electronic file constitutes a submission of the claims to the payer for processing by the payer; receiving, over the network, by the computer system operated on behalf of the provider, in electronic form, from the computer system operated on behalf of the payer, a set of explanation of benefits records that are responsive to claims in the electronic file of the provider, in such a manner that each explanation of benefits record responsive to a given claim contains (i) the first unique identifier corresponding to the given claim from the electronic file of the provider, and (ii) the second unique identifier associated with each line item of the given claim; for each explanation of benefits record received from the payer, storing, by the computer system operated on behalf of the provider, the explanation of benefits record in association with its corresponding first unique identifier; in connection with any transaction involving an unfavorable adjudication by the payer, of a line item of a selected claim, storing, by the computer system operated on behalf of the provider, as denial data the transaction in association with the second unique identifier for the unfavorably adjudicated line item of the selected claim; and retrieving, by the computer system operated on behalf of the provider, the stored denial data, in conjunction with corresponding line item data, to provide an electronic denial management output, for use by the provider in responding to the payer.