System and method for operating modules of a claims adjudication engine

A system for configuring an adjudication system to adjudicate a claim transaction, the system comprising:

• an adjudication system for receiving the claim transaction containing at least one line item describing an insured service for a recipient to be financed by a payer for the insured service;
• an adjudication engine of the adjudication system for coordinating the adjudication processing of the received claim transaction;
• a plurality of data containers coupled to a database for representing the claim transaction such that the data containers are selectable from a set of available data containers, the data containers coupled to the adjudication engine and configured for containing data instances of the claim transaction;
• and
• a plurality of adjudication modules for coupling to the plurality of data containers, the plurality of adjudication modules selectable from a set of available adjudication modules, the adjudication modules configured for providing business logic for application to the data containers during the adjudication processing to manipulate the data instances of the data containers;
• wherein the configured adjudication system adjudicates the data instances of the data containers according to the business logic of the selected adjudication modules for determining an adjudication status of the claim transaction.

A computer program product for configuring an adjudication system to adjudicate a claim transaction, the computer program product comprising:

• a computer readable medium;
• an adjudication system module stored on the computer readable medium for receiving the claim transaction containing at least one line item describing an insured service for a recipient to be financed by a payer for the insured service;
• an adjudication engine module coupled to the adjudication system module for coordinating the adjudication processing of the received claim transaction;
• a data container module coupled to the adjudication system module for providing a plurality of data containers coupled to a database for representing the claim transaction such that the data containers are selectable from a set of available data containers, the data containers coupled to the adjudication engine module and configured for containing data instances of the claim transaction;
• and
• a plurality of adjudication modules for coupling to the plurality of data containers, the plurality of adjudication modules selectable from a set of available adjudication modules, the adjudication modules configured for providing business logic for application to the data containers during the adjudication processing to manipulate the data instances of the data containers;
• wherein the configured adjudication system module adjudicates the data instances of the data containers according to the business logic of the selected adjudication modules for determining an adjudication status of the claim transaction.