Importance

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Abstract

A system and method for revising one or more hierarchies of an insurance plan, the insurance plan for use in adjudicating one or more insurance claims. The method and system comprising obtaining one or more claims from a claims queue, the claims queue for storing claims selected for review. The system and method comprising accessing at least one of a set of benefit codes or a set of adjudication rules associated with the insurance plan of the obtained one or more claims, wherein at least some of the set of benefit codes or the set of adjudication rules are structured in a plurality of containers. The system and method comprising reconfiguring selected content of the at least one of a set of benefit codes or the set of adjudication rules in view of identified reasons for review of the one or more claims; and storing the reconfigured at least one of a set of benefit codes or the set of adjudication rules in a memory for subsequent use as at least one of a redeployed version of the insurance plan or a revised said at least one of a set of benefit codes or the set of adjudication rules for use in development of other insurance plans for adjudication of claims other than the one or more claims obtained from the claims queue; wherein the revised insurance plan, once deployed, is adapted for use by an adjudication engine for processing insurance claims received by the adjudication engine.

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First Claim