Abstract: A method includes receiving a first claim line identifying a first time span and a first quantity of a health care service provided, and a second claim line identifying a second time span and a second quantity of the health care service provided; determining whether the quantity of health care service provided during the first time span exceeds a maximum amount for a predefined time period; generating a payment recommendation for the first claim line; determining whether a beginning date of the second time span is within the predefined time period and, if so, extending the predefined time period past an ending date of the second time span and generating a payment recommendation for the second claim line in response to determining whether the quantity in the first and second claim lines exceeds a maximum amount for the extended time period.

Abstract: Systems, methods, apparatus, and computer program products are provided for processing claims. In various embodiments, claims can be processed in accordance with a data-driven approach that limits changes to existing claims processing rules by using an inclusions table, an exclusions table, and/or a decision table as part of firing or executing claims processing rules to accommodate for such changes.

Abstract: Systems, methods, apparatus, and computer program products are provided for processing claims. In various embodiments, claims can be processed in accordance with a data-driven approach that limits changes to existing claims processing rules by using exclusion tables, inclusion tables, and/or decision tables to change or execute rules in a more efficient manner.

Abstract: Systems, methods, apparatus, and computer program products are provided for processing claims. In various embodiments, claims can be processed in accordance with a data-driven approach that limits changes to existing claims processing rules by using exclusion tables, inclusion tables, and/or decision tables to change or execute rules in a more efficient manner.

Abstract: Systems, methods, apparatus, and computer program products are provided for processing claims. In various embodiments, claims can be processed in accordance with a data-driven approach that limits changes to existing claims processing rules by using an inclusions table, an exclusions table, and/or a decision table as part of firing or executing claims processing rules to accommodate for such changes.

Abstract: Systems, methods, apparatus, and computer program products are provided for processing claims. In various embodiments, claims can be processed in accordance with a data-driven approach that limits changes to existing claims processing rules.

Abstract: Systems, methods, apparatus, and computer program products are provided for processing claims. In various embodiments, claims can be processed in accordance with a data-driven approach that limits changes to existing claims processing rules.

Abstract: Systems, methods, apparatus, and computer program products are provided for processing claims. In various embodiments, claims can be processed in accordance with a data-driven approach that limits changes to existing claims processing rules.