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System and method for machine based medical diagnostic code identification, accumulation, analysis and automatic claim process adjudication
System and method for machine based medical diagnostic code identification, accumulation, analysis and automatic claim process adjudication
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机译:基于机器的医学诊断代码识别,累积,分析和自动索赔过程裁决的系统和方法
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摘要
A context sensitive methodology, a Structured Virtual Construct (SVC) system, data tagging techniques, and an apparatus are provided for performing Medical Code-based decision-making involving the matching of a given medical identified element against one or more of a set of known or reference medical identified elements from history or other data elements. A satisfactory decision is achieved as a function of both aggregated ranking (AR) and account adjudication (AA), where account adjudication refers to the full set of values garnered by the Medical Code accumulation process in the process of generating approval/denial/re-classification/of medical diagnosis and/or claim events.
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