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.