Abstract: A system for processing healthcare claims and remittances comprises a database and an electronic portal. The database contains previously received healthcare claims from a plurality of healthcare providers and previously received remittances from a plurality of payers. The electronic portal, connected to the database, receives a healthcare claim from a provider or a remittance from a payer, and splits the received claim or remittance into a plurality of data elements. The portal assigns a unique identifier and a shared identifier to each of the data elements of the received claim or remittance. The portal performs a duplicate claim edit and/or a third party liability edit on the received claim, or performs a duplicate remittance edit an/or a third party payment edit on the received remittance. Based on the result of the edits, the portal submits the received claim to a payer or submits the received remittance to a provider.

Abstract: A scalable healthcare claim resolution and workflow management system is provided which resolves healthcare claim discrepancies and disputes among multiple healthcare payers and providers. The system can also be used to communicate and track claims within a single organization. The claim resolution system facilitates communication between parties while maintaining an inventory and tracking claim disputes within the system. The system standardizes the inefficient and disparate systems found in the art.