Method and apparatus for repricing a reimbursement claim against a contract
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United States of America Patent
Stats
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Mar 26, 2013
Grant Date -
May 24, 2012
app pub date -
Jan 18, 2012
filing date -
Oct 14, 1999
priority date (Note) -
In Force
status (Latency Note)
Importance
Abstract
A method for repricing a reimbursement claim under at least one contract is provided herein. The method may include a combination of steps such as: converting each contract into a series of contractual terms; converting a claim into a series of claim lines, containing claim codes, unit numbers and corresponding charges for the claim codes; comparing claim codes and contractual terms and identifying matches therebetween; determining any priority conditions associated to the matching contractual terms, and eliminate any matching contractual terms that are excluded by the priority conditions; calculating the reimbursement amount for the claim by determining the reimbursement charges for the non-excluded matching contractual terms; and determining and making any adjustments depending upon any discount terms for the entire reimbursement amount.
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