Abstract: Proactive resolution of coordination of benefits (COB) issues is provided. Payer data is received as membership files from a plurality of payers, the payer data including eligibility and member demographic data. Upon detection of new or modified information, a normalizing engine may be utilized to normalize name information, address information, and social security number information into a format for comparing with other stored payer data according to various rules. A matching engine may be utilized to compare the normalized payer data against other insurance provider data to determine COB instances by discovering matches or partial-matches of member information. A set of rules may be applied to determine a primary versus a secondary payer. An output file, which may comprise matches and COB determinations, raw data, and a web interface for accessing archived reports and files and to generate individual member searches, may be provided to one or more payers.

Abstract: Ensuring that a user's demographic data is correct so that billing statements may be sent to a correct address for collecting payment(s) from the user is a challenge many service providers face. Automatic information standardization and verification is provided. When a user's demographic information is inputted into an information system, address information is standardized into a standard format, a breadth of a verification to perform for the user is determined, and cross-matching the user's demographic information with information provided by one or more third party data sources is performed. Results may be provided in near real-time so that any inconsistencies may be corrected on the front-end and thus avoid unnecessary operation costs and improving billing and statement delivery.

Abstract: Front-end patient financial triage is provided, wherein various financial clearance checks may be processed prior to proceeding with a non-emergent patient encounter. A patient's credit history, historic payment information, and symptoms of his/her financial health, such as employment and income, family size, etc., as well as address and social security number verification may be utilized to help a health care provider determine if a patient may pay for health care services. A web-based configuration tool may be provided for allowing the health care provider to dynamically change rules that define cascading processes of a financial clearance transaction. A health care provider may be able to use this actionable financial information to make better up-front decisions about which financial category may be most appropriate for a patient. Embodiments may help to protect a health care provider's financial liability, reduce bad debt and preventable write-offs.

Abstract: Proactive resolution of coordination of benefits (COB) issues is provided. Payer data is received as membership files from a plurality of payers, the payer data including eligibility and member demographic data. Upon detection of new or modified information, a normalizing engine may be utilized to normalize name information, address information, and social security number information into a format for comparing with other stored payer data according to various rules. A matching engine may be utilized to compare the normalized payer data against other insurance provider data to determine COB instances by discovering matches or partial-matches of member information. A set of rules may be applied to determine a primary versus a secondary payer. An output file, which may comprise matches and COB determinations, raw data, and a web interface for accessing archived reports and files and to generate individual member searches, may be provided to one or more payers.