About This Architecture
Healthcare claims remittance (835) processing architecture ingests insurance company payment files via SFTP/API, parses and validates them, then intelligently routes claim lines through denial and underpayment workflows. The system classifies each payment line, applies routing rules, and triggers specialized handlers—denial analyzer for zero-payment claims and variance calculator for partial payments—with manual review gates and notification outputs. Centralized logging, metrics dashboards, and alerting provide full observability across the ingestion, classification, and workflow layers. Fork this diagram to customize routing logic, add new workflow branches, or integrate with your claims management platform.