System and Method for Fee Schedule Download, Comparison and Reconciliation Against Processed Medical Insurance Claims

摘要

The present claims processing system relates generally to the claims adjustment process, medical payment process, medical payment auditing, and the utilization of blockchain and artificial intelligence (“AI”) to analyze and process claims. The present invention may implement blockchain technology and AI to automate Provider Fee Schedule and CMS Fee Schedule reconciliation and claim management by i) comparing fees schedules across multiple years and CMS codes; ii) validating payments made to the provider by CMS; and iii) performing a pre-check of claims rate validity for medical providers prior to submission for payment.