AUTOMATED SYSTEM AND METHOD FOR HEALTH CARE ADMINISTRATION

An information collection and processing system and related automated method are provided for use by an alliance of organizations providing health care to a given population. The system includes an arrangement for storing information relating to a plurality of contractual relationships existing between the alliance of organizations, a plurality of health care providers, and a plurality of payors (e.g., insurance companies). The storage arrangement also includes a portion for storing information relating to a plurality of patients in the given population, and another portion for storing information relating to transactions between the alliance, the providers and the payors. An aspect of the system and method relates to its capability of storing information relating to an expected receivable resulting from an encounter between a patient and one or more of the providers, storing information relating to a corresponding remittance received as a result of said encounter, comparing the expected receivables with the corresponding remittances, and initiating an action if the remittance falls outside of predetermined limits of the respective receivable. Provisions are made for similar operations involving capitation agreements.