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.

People also ask

How should I architect a healthcare 835 remittance processing system to handle denials and underpayments?

This diagram shows a complete 835 remittance processing architecture that ingests insurance payment files via SFTP/API, parses and validates them, then routes claim lines through specialized denial and underpayment workflows based on payment amount. Each workflow includes analysis, manual review gates, notifications, and persistent records, with centralized logging and alerting for full observabil