System for processing healthcare claim data

A system for processing claim data related to provision of healthcare to a patient, comprising:

• a rules processor for processing acquired claim data to identify a condition triggering application of a first set of rules for determining validity of an individual claim element;
• a claim data collator for collating individual claim element data for a particular patient for submission to a payer;
• a source of a second set of rules for use in processing collated claim data;
• a pre-processor for submitting said collated claim data for processing using said second set of rules to validate said collated claim data is in condition for processing to initiate generation of payment;
• and
• a claim processor, for submitting said collated claim data to a payer, in response to successful validation by said pre-processor.

A method for processing claim data related to provision of healthcare to a patient, comprising the steps of:

• collating data related to a claim for a particular patient for submission to a payer;
• processing collated claim data using predetermined rules to validate said collated claim data is in condition for processing to initiate generation of payment;
• and
• submitting said collated claim data to a payer, in response to successful validation by said pre-processor.