The present claim repricing system generally includes a processor and a
program and data memory coupled to the processor. The memory stores the
requisite database tables, as well as program instructions for repricing
several different types of claims, including physician, inpatient, and
outpatient claims. The claim repricing system includes instructions for
determining availability of insurance plan coverage to the patient based
on an effective date of the employer insurance plan, as well as
determining the availability of the physician or provider based on an
effective provider date. The claim repricing system further handles
specialty codes and exceptions. For example, the claim repricing system
includes instructions for determining the presence of anesthesia specialty
codes, and for determining the correct number of anesthesia units and an
anesthesia repricing indicator. The anesthesia repricing indicator may be
a percentage discount, for example, or a rate. Furthermore, the claim
repricing system may operate in a batch processing mode to quickly,
accurately, and reliable reprice large amounts of claims.
