Abstract: Systems and methods for a computer machine system including one first computer memory having a first database and a second database. The first database is configured to store eligibility data for individuals associated a group healthcare plan, a set of user identifiers, one or more demographic information from the specific user, and one or more eligibility data. The second database is configured to store a plurality of rules for a claim submission associated with each group healthcare plan, originating payors associated with the claim submission, each originating payors having at least one data submission requirement associated with the claim submission, and a rule for a processed claim submission associated with each of the plurality of originating payors. The originating payors transmit the eligibility data for the individuals associated with the group healthcare plan such that the data submission requirement for each of the originating payors is mapped to the database.

Abstract: Systems and methods for a computer machine system including one first computer memory having a first database and a second database. The first database is configured to store eligibility data for individuals associated a group healthcare plan, a set of user identifiers, one or more demographic information from the specific user, and one or more eligibility data. The second database is configured to store a plurality of rules for a claim submission associated with each group healthcare plan, originating payors associated with the claim submission, each originating payors having at least one data submission requirement associated with the claim submission, and a rule for a processed claim submission associated with each of the plurality of originating payors. The originating payors transmit the eligibility data for the individuals associated with the group healthcare plan such that the data submission requirement for each of the originating payors is mapped to the database.