Health Claims Processing

Executive Summary

There is no single method for processing health claims. In fact, system vendors and health plans would argue the uniqueness of their particular system and its advantages over other systems: the security of a port of entry into a mainframe system, the customization associated with service-oriented architecture (SOA), etc. Despite system differences, there are common architectural features one would find in any good health claims processing system.

• Data and processing criteria stored in tables
• Fully developed set of reporting tools
• Robust processing engine
• Configurable access to data