Abstract: A method and system for processing health care service transaction approval (STA) requests, such as referral requests, a pre-certification requests or service authorization requests. The method automates the processes of sending electronic STA requests to payers, receiving electronic replies to the STA requests from the payers and presenting information contained in the STA replies to users in a readily discernable manner. The system is configured for providing the various functions of the method.

Abstract: A system (200) and method (400) for automatically handling health care claim status requests (228) and responses (232). The system includes a health care software application (246) that provides patient invoice functionality relating to health care claims submitted to various payers (216), e.g., insurance companies. A claim status transaction software module (258) includes a routing software sub-module (282) that intelligently routes responses received from payers within the system so that a variety of follow-up activities may be performed. The routing software sub-module routes the responses as a function of information contained in the responses. The system also includes a pre-checking software sub-module (272) that performs a variety of checks on each claim status request prior to the system sending that request. If a request fails a pre-check, the response can be automatically placed onto a follow-up list (296) for follow up.