Abstract: A method includes receiving a claim associated with a patient and destined for a first payor from a provider; assessing a likelihood that the first payor is not liable for an entirety of the claim; identifying a second payor responsive to the likelihood that the first payor is not liable for the entirety of the claim exceeding a liability threshold; and routing the claim to the first payor, to the second payor, or to the provider based on routing rules provided by the first payor.

Abstract: A method includes generating a payor channel capacity model by modeling a channel capacity between a resource management system and a payor; generating a transaction request model by modeling transaction requests destined for the payor; defining a plurality of Quality of Service (QoS) bands based on the payor channel capacity model and the transaction request model, respective ones of the plurality of QoS bands being indicative of a measure of relative opportunity to establish a connection on the channel between the resource management system and the payor; receiving a current transaction request for the payor at the resource management system; assigning the current transaction request to one of the QoS bands; and establishing a current connection on the channel between the resource management system and the payor to communicate the current transaction request from the resource management system to the payor based on the QoS band assigned to the current transaction request.