Multiple eligibility medical claims recovery system

Abstract

A multiple eligibility medical claims recovery architecture. A system is provided to perform post-processing of existing claims that were incorrectly filed in accordance existing claims reimbursement rules and regulations. The system is operable to further provide filtering, either locally or remotely, of claims submitted by a health care provider to a payor in a multiple-eligibility regime. Still further, the system is configurable to provide automatic filing of the claims to multiple payors on behalf of the health care provider. A system is provided to interact with other (PBM) systems and technology to provide real-time processing of claims submitted to determine if claims are correctly filed, pass those that are and reject those that are not and provide a means by which such rejected claims can be completed and redirected to the appropriate payer for approval and payment.

Dependencies are inferred from the claim text.