Abstract: Methods and systems for adjudicating claims in health services environments are presented. An exemplary method for processing service provider claims for payment includes scheduling appointments with service providers, receiving claims from the service providers, determining whether at least one scheduled appointment corresponds with at least one received claim and determining that at least one scheduled appointment has not been identified as corresponding to at least one received claim within a predetermined period of time. Optionally, the method includes presenting the particular received claim for payment when at least one of the scheduled appointments corresponds to the particular received claim.

Abstract: An exemplary method for determining the appropriateness of service provider claims for payment includes scheduling appointments for patients with service providers based on requests for services, generating appointment information corresponding to each of the scheduled appointments, and capturing service information corresponding to claims received from the service providers for payment of charges associated with services rendered by the service providers to the patients. The method further includes automatically identifying candidate appointments that correspond to a particular received claim based on a degree of similarity between the service information associated with the particular received claim and the appointment information associated with the scheduled appointments.

Abstract: Methods and systems for adjudicating claims in health services environments are presented. An exemplary method for processing service provider claims for payment includes receiving a claim for payment, automatically identifying candidate appointments from a plurality of scheduled appointments based on a degree of similarity between service information associated with the received claim and appointment information associated with the scheduled appointments, analyzing the candidate appointments to determine whether to flag the received claim for resolution, and presenting the received claim for payment when at least one of the candidate appointments corresponds to the received claim.

Abstract: Methods and systems for acquiring claims in health services environments are presented. An exemplary method for processing service provider claims for payment includes: scheduling appointments with the service providers, receiving claims from the service providers, analyzing the scheduled appointments to identify at least one scheduled appointment corresponding to each of the received claims, automatically detecting scheduled appointments not identified as corresponding to any of the received claims within a predetermined period of time, and notifying respective service providers that no claims have been received for the detected scheduled appointments.