METHODOLOGY, SYSTEM AND COMPUTER PROGRAM PRODUCT FOR GENERATING ELECTRONIC INSURANCE CLAIMS OR BILLS, HAVING OPTIMIZED INSURANCE CLAIM ITEMS IN ORDER TO MAXIMIZE REIMBURSEMENT AND TO FACILITATE APPROVAL OF THE CLAIM(S) UPON FIRST SUBMISSION TO THE INSURANCE CARRIER

摘要

A methodology, system and computer program product for generating electronic insurance claims or bills, having optimized insurance claim items based on the insurance carrier(s) of a patient are provided. The method includes receiving insurance carrier data which identifies the patient in order to facilitate payment upon first submission to the carrier. The method includes receiving carrier data, which identifies the patient's insurance carrier(s) and patient data, which identifies the patient. The method also includes receiving treatment data, which identifies drugs administered to the patient and procedures performed on the patient on a given date of service. The treatment data is processed to generate nurse documentation, such as treatment and/or flow sheets. Electronic insurance claims or bill are automatically generated having optimized reimbursable insurance claim items, including predetermined codes based on the treatment data and the insurance carrier data to facilitate approval of the bill by the at least one insurance carrier.