SYSTEMS AND METHODS FOR BENEFIT PLAN QUALITY ASSURANCE AND CERTIFICATION

摘要

A system for testing a benefit plan for quality assurance is provided. A test adjudication engine is configured to process claims in accordance with the benefit plan, each of the claims having one or more parameters. A database is configured to store the benefit plan and quality assurance data, the quality assurance data including: (a) historical claims, each historical claim having an associated historical adjudication, and (b) new claims, each new claim not having an associated historical adjudication. An interactive dashboard is configured to allow a user to batch claims for processing by the test adjudication engine, from among the historical claims and the new claims, based on the one or more parameters.