Methods, apparatus and computer program products for processing claims

An apparatus for processing an original batch comprising a plurality of health care claims, the apparatus comprising a processing element configured to:

• receive the plurality of health care claims packaged in at least one envelope and including information regarding a submitter and a payor;
• validate the information regarding the submitter and the payor and generate an error message if the information is invalid;
• if the information regarding the submitter and the payor is valid, analyze the at least one envelope and the plurality of health care claims for compliance with a predefined specification;
• if non-compliance is identified, determine if information associated with one of a provider or a subscriber is errant and then remove the health care claims relating to any provider or subscriber for which the associated information is determined to be errant;
• and
• if non-compliance is identified and the information associated with one of a provider or a subscriber is not errant, then process the plurality of health care claims by:
• separating the plurality of health care claims into a plurality of in-process batches without consideration of compliance of the documents of the in-process batches;
• following separation of the documents into the plurality of in-process batches, identifying if the documents of the in-process batches are either non-compliant documents that fail to comply with a predefined specification or compliant documents that do comply with the predefined specification;
• forming at least one non-compliant batch containing the non-compliant documents and at least one compliant batch containing the compliant documents based upon the identification of the documents as being either compliant or non-compliant;
• and
• providing an output based upon at least one of the non-compliant batch and the compliant batch.

A computer program product for processing an original batch comprising a plurality of health care claims, the computer program product comprising at least one computer-readable storage medium having computer-readable program code portions stored therein, the computer-readable program code portions comprising:

• a first executable portion for receiving the plurality of health care claims packaged in at least one envelope and including information regarding a submitter and a payor;
• a second executable portion for validating the information regarding the submitter and the payor and generating an error message if the information is invalid;
• if the information regarding the submitter and the payor is valid, a third executable portion for analyzing the at least one envelope and the plurality of health care claims for compliance with a predefined specification;
• if non-compliance is identified, a fourth executable portion for determining if information associated with one of a provider or a subscriber is errant and then removing the health care claims relating to any provider or subscriber for which the associated information is determined to be errant;
• and
• if non-compliance is identified and the information associated with one of a provider or a subscriber is not errant, a fifth executable portion for then processing the plurality of health care claims by:
• separating the plurality of health care claims into a plurality of in-process batches without consideration of compliance of the documents of the in-process batches;
• following separation of the documents into the plurality of in-process batches, identifying if the documents of the in-process batches are either non-compliant documents that fail to comply with a predefined specification or compliant documents that do comply with the predefined specification;
• forming at least one non-compliant batch containing the non-compliant documents and at least one compliant batch containing the compliant documents based upon the identification of the documents as being either compliant or non-compliant;
• and
• providing an output based upon at least one of the non-compliant batch and the compliant batch.