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Method of adjudicating medical claims based on scores that determine medical procedure monetary values

机译:根据确定医疗程序货币价值的分数来裁定医疗索赔的方法

摘要

A method of adjudicating a medical claim includes providing a requirements for a first claim and a second claim, receiving a medical claim for a medical procedure, setting a first score for the first claim and a second score for the second claim to an initial value, comparing components of the medical claim to the requirements of the first and second claims, changing the first and second scores for each one of the components that match one of the requirements and for each one of the requirements that is missing from the components, and selecting the first or second claim based upon predetermined criteria applied to their respective scores to determine either a monetary value of the medical procedure for a medical service provider associated with the medical procedure or a monetary value of medical coverage for a patient associated with the medical procedure.
机译:判定医疗要求的方法包括:提供对第一要求和第二要求的要求;接收针对医疗程序的医疗要求;将第一要求的第一得分和第二要求的第二得分设置为初始值;将医疗要求的组成部分与第一和第二个要求的要求进行比较,更改与该要求之一匹配的每个组成部分以及该组件中缺少的每个要求的第一和第二分值,然后选择第一或第二权利要求基于应用于其相应分数的预定标准来确定与该医疗程序相关的医疗服务提供者的医疗程序的货币价值或与该医疗程序相关的患者的医疗保险的货币值。

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