Abstract: A computer program more efficiently and accurately categorizes healthcare claims into in-network claims and out-of-network claims, in order to determine whether the non-network hospitals that have submitted healthcare claims may be good candidates for joining a centralized network. Good candidates can be added to the network. Members of the centralized network agree to waive all or a portion of a deductible amount owed as part of their contractual obligation with the network. Insurance providers agree to provide a credit of the premium to be paid by beneficiaries that use a contracted medical facility to receive a service for which the deductible amount is waived. The cost savings and increased revenue recognized by both medical facilities and insurance providers can enable claims to be re-priced while reducing transactional costs for all parties.

Abstract: A computer program more efficiently and accurately categorizes healthcare claims into in-network claims and out-of-network claims, in order to determine whether the non-network hospitals that have submitted healthcare claims may be good candidates for joining a centralized network. Good candidates can be added to the network. Members of the centralized network agree to waive all or a portion of a deductible amount owed as part of their contractual obligation with the network. Insurance providers agree to provide a credit of the premium to be paid by beneficiaries that use a contracted medical facility to receive a service for which the deductible amount is waived. The cost savings and increased revenue recognized by both medical facilities and insurance providers can enable claims to be re-priced while reducing transactional costs for all parties.