Importance

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Abstract

A method and system for a generic mechanism for adjudication of claims in a claims processing system. The generic mechanism comprises a Web services module, a Web portal, a batch loader, a claim database, and an interface engine. The Web services module, the Web portal, and the batch loader are used by medical providers to submit claims. Upon submission, claim information is converted to generic messages and sent to the interface engine. The interface engine validates the generic messages using a claim schema, prior to converting them to an internal message format, and sending them to a clearing house application. When messages are adjudicated by the clearing house application, they are returned to the interface engine, where the return messages are converted back to generic messages and validated against a return message schema. Valid messages along with any error are returned to the medical providers and submitted for payment approval.

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First Claim