20140278505 | System for Processing and Settling Health Care Benefit Claims - An automated system for administering health care insurance claims utilizes a series of rules, including a hierarchal set of Super Rules, specific Client Rules and General Rules, to apply selected criteria to the parameters of each respective insurance claim. When the criteria of a rule filter is met by the specific insurance claim parameters, an action is applied to the claim, allowing the insurance claim to be resolved without manual negotiation of the claim. If the criteria of none of the rule filters are met, the default action is a manual negotiation of the insurance claim by the claims administrator who is provided with a monitor display containing the pertinent information needed to negotiate a settlement discount for the health care service provided. The automated system provides a filter template to facilitate the creates of new rules to be applied to the administration of an insurance claim. | 09-18-2014 |