HEALTH PLAN OPERATORS MANAGEMENT SYSTEM WITH ARTIFICIAL INTELLIGENCE MODULE IN MEDICAL AUDIT AUDITING

摘要

HEALTH PLAN OPERATORS MANAGEMENT SYSTEM WITH ARTIFICIAL INTELLIGENCE MODULE IN MEDICAL AUDIT AUDITING. This patent is a health insurance carrier management system that has the purpose of performing all necessary operations in this segment, as follows: Registration, Medical Accounts, Medical Payment, Billing, Legal Obligations, Commissions and Auditing of Accounts, with a business rules configurator module. Its purpose is to perform the entire operation of a Health Plan Operator through an artificial intelligence module. It works as follows: All medical procedure attendance guides are validated by a computerized system, where data are sent to a rule processor, which were previously registered in a configurator module, where returns occur, being at the discretion The auditor, depending on his or her level of engagement, accepts or declines to charge a procedure that has been alerted as non-standard.