Medicare Claims Management System

Medicare plays a vital role in a real time environment. Medicare can contribute to a significant part of a country's economy. Medicare is the maintenance or improvement of health. Access to health care varies across countries, groups, and individuals, largely influenced by social and economic conditions as well as the health policies in place. In this paper a system and method for a rules-based pre-adjudication of a benefits claim submission is disclosed. The reviewing and adjudicating medical insurance claims is done electronically. In support medical procedure eligibility verification, patient referrals, treatment authorization, data entry editing, electronic claim submission, claim status determination and electronic remittance processing is also done. The system can handle both individual and family insurance policies. The claims processing system performs automatic adjudication on submitted claims. The payment tracking system allows health care providers to monitor the payment status of a claim after submission.