Reimbursement claim processing simulation and optimization system for healthcare and other use

摘要

A system permits a healthcare provider to perform flexible, efficient, and timely multiple analyses of managed care organization (MCO) contracts, over a large database of historical information, to provide associated profitability information. An interface processor receives data representing multiple, different financial claims for reimbursement based on multiple, different predetermined reimbursement formulae. A source of data represents multiple calculable expressions. A repository includes data associating a particular calculable expression with multiple, different reimbursement formulae, and data associating particular financial claim data with particular reimbursement formulae. A data processor uses the repository to identify financial claim data of the data representing multiple different financial claims associated with particular reimbursement formula, and to initiate execution of a procedure comprising the particular calculable expression, derived from the source, to provide calculated data for use in determining reimbursement based on different reimbursement formulae.