Automated workflow in emergency medical services billing

A system for automatically processing emergency medical claims, the system comprising:

• a payer plan database storing payer plan information;
• one or more processors, and a memory, the memory containing instructions that, when executed by the processor, cause the processor to:
• receive an emergency medical claim;
• identify a payer of the claim based on information provided in the claim;
• determine an expected claim payment amount to be collected from the payer based on one or more medical services listed in the claim;
• adjust the expected claim payment amount based on at least one of a payment schedule of the payer, a past payment of the payer for a same type of claim, patient eligibility, patient co-payment, patient deductible, patient co-insurance, and a determined collection risk.

A system for automatically processing emergency medical claims, the system comprising:

• one or more processors and a memory, the memory containing instructions that, when executed by the processor, cause the processor to:
• receive an emergency medical claim;
• identify a payer of the claim;
• and
• determine an amount to be collected from the payer, based on a payment schedule of the payer, wherein the payment schedule of the payer is associated with a third party.

A system for automatically processing emergency medical claims, the system comprising:

• one or more processors and a memory, the memory containing instructions that, when executed by the processor, cause the processor to:
• receive an emergency medical claim;
• identify a payer of the claim;
• and
• determine an amount to be collected from the payer, based on a past payment of the payer for a same type of claim.