Below is  a Health Care Claims Application data model structure. 

Hospitals

• Hospital_ID
• Hospital_Name
• Other_Hospital_Details

Claims

• Claim_ID
• Claim_Status_Code
• Hospital_ID
• Insurance_Company_ID
• Patient_ID
• Updated_Date
• Amount_Claimed
• Amount_Paid
• Other_Claim_Details

Claim Status

• Claim_Status_Code
• Claim_Status_Description(In Dispute, Settled)

Claim Dispute Management

• Dispute_Area_Code
• Dispute_Area_Description(None,Consultation,Medication,Treatment)

Patients

• Patient_ID
• Gender
• Date_Of_Birth
• Patient_Name
• Patient_Address
• Other_Patient_Details

Insurance Companies

• Insurance_Company_ID
• Insurance_Company_Name
• Insurance_Company_Other_Details

Staff

• Staff_ID
• Staff_Category_Code
• Gender
• Staff_Firstname
• Staff_Lastname
• Staff_Qualifications
• Staff_Birth_Date
• Staff_Other_Details

Claim Processing Module

• Claim_ID
• Process_Date
• Dispute_Area_Code
• Processor_Staff_ID
• End_Date
• Step_Descriptions

Reference: http://www.databaseanswers.org/data_models/health_insurance_claims/index.htm