Patent ID: 6879959

Claim:
A method of adjudicating a medical claim comprising: providing a first plurality of requirements for a first claim; providing a second plurality of requirements for a second claim wherein the second claim has a higher monetary value than the first claim; electronically receiving the medical claim for a medical procedure; setting a first score for the first claim to an initial value; setting a second score for the second claim to the initial value; electronically comparing a plurality of components of the medical claim to the first and second pluralities of requirements; electronically changing the first score in a first manner for each one of the plurality of components that match one of the first plurality of requirements; electronically changing the first score in a second manner for each one of the first plurality of requirements that is missing from the plurality of components; electronically changing the second score in the first manner for each one of the plurality of components that match one of the second plurality of requirements; electronically changing the second score in the second manner for each one of the second plurality of requirements that is missing from the plurality of components; and electronically selecting one of the first and second claims based upon predetermined criteria applied to their respective scores to determine a monetary value of the medical procedure for a medical service provider associated with the medical procedure, wherein electronically selecting one of the first and second claims based upon predetermined criteria applied to their respective scores to determine the monetary value of the medical procedure for the medical service provider associated with the medical procedure further comprises: if the first score was changed only in the first manner and if the second score was changed in the second manner, settling the medical claim as the first claim; if the first score was changed in the second manner and if the second score was changed only in the first manner, settling the medical claim as the second claim; if the first and second scores were changed only in the first manner and: if the first score is further away in the first manner from the initial value than the second score, settling the medical claim as the first claim; if the second score is further away in the first manner from the initial value than the first score, settling the medical claim as the second claim; and if the first and second scores are identical to each other, settling the medical claim as the first claim; and if the first and second scores were changed in the second manner and: if the first score is further away in the first manner from the initial value than the second score, settling the medical claim as the first claim; if the second score is further away in the first manner from the initial value than the first score, settling the medical claim as the second claim; and if the first and second scores are identical to each other, settling the medical claim as the first claim.