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Systems and methods of processing and reconciling healthcare related claims

机译:处理和协调医疗保健相关权利要求的系统和方法

摘要

Systems and methods for a computer machine system including one first computer memory having a first database and a second database. The first database is configured to store eligibility data for individuals associated a group healthcare plan, a set of user identifiers, one or more demographic information from the specific user, and one or more eligibility data. The second database is configured to store a plurality of rules for a claim submission associated with each group healthcare plan, originating payors associated with the claim submission, each originating payors having at least one data submission requirement associated with the claim submission, and a rule for a processed claim submission associated with each of the plurality of originating payors. The originating payors transmit the eligibility data for the individuals associated with the group healthcare plan such that the data submission requirement for each of the originating payors is mapped to the database.
机译:用于计算机机系统的系统和方法,包括具有第一数据库和第二数据库的一个第一计算机存储器。 第一数据库被配置为存储相关联的各个数据的资格数据,与组医疗保健计划,一组用户标识符,来自特定用户的一个或多个人口统计信息以及一个或多个资格数据。 第二数据库被配置为存储与每个组医疗保健计划相关联的索赔提交的多个规则,始发与索赔提交相关联的付款人,每个始发的付款人具有至少一个与索赔提交相关的数据提交要求,以及规则 与多个始发的付款人中的每一个相关联的加工索赔提交。 始发的付款人发送与组医疗保健计划相关的个人的资格数据,使得每个始发的付款人的数据提交要求映射到数据库。

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