System and Method for Standardized and Automated Appeals Process

A computerized system for an automated appeal process, comprising:

• a server comprising an electronic database for storing appeal data, wherein the computer is further configured or arranged to:
• electronically store data descriptive of a plurality of health care benefit appeals in the electronic database;
• electronically convert appeal data from one or more of the plurality of appeals to a predetermined appeal format;
• and
• transmit at least a portion of the converted appeal data to a health care benefit payer, wherein the appeal data relates to a request for reconsideration of a determination of entitlement to benefits or services.

A computerized method for an automated appeal process, comprising:

• receiving electronic appeal data from a health care provider;
• electronically storing the appeal data from the health care provider in a computerized database;
• receiving an identification of a basis for an appeal;
• automatically generating an appeal submission comprising the identified basis for the appeal and arranged according to a predetermined format;
• and
• sending the formatted appeal submission to a health care benefit payer, wherein the appeal relates to a request for reconsideration of a determination of entitlement to benefits or services.

A computerized method for automating an appeal process, comprising:

• electronically storing data descriptive of a plurality of health care benefit appeals in a computerized database;
• receiving appeal data having been converted to predetermined appeal format, wherein the converted appeal data is based on the data descriptive of a plurality of health care benefit appeals;
• and
• transmitting at least a portion of the converted appeal data to a health care benefit payer, wherein the appeal data relates to a request for reconsideration of a determination of entitlement to benefits or services.