Automation of auditing claims
AssigneeHyperQuest, Inc.
InventorsDennis M. Hogan, Jeffrey J. Hogan
Life of this patent
Estimating the term…
Abstract
Described are computer-based methods and apparatuses, including computer program products, for automation of auditing claims. A data file is received comprising one or more auditable items, each auditable item comprising a word string having one or more words. Each word string for each auditable item is translated using one or more translation steps into a translated item description. Each translated item description is compared to a plurality of terms to generate matching information. Each translated item description is associated with an item identifier based on the matching information. Each auditable item is accepted or rejected based on the item identifier and one or more rules associated with the data file.
Claims22
1-37. (canceled)
A computerized auditing method comprising:
- translating, using a processor, a word string of an auditable item using one or more translation steps into a translated item description, wherein the auditable item is a line item from an insurance claim file;
- and
- using a processor, automatically accepting or automatically rejecting the auditable item based on the translating, wherein translating the word string comprises:
- applying one or more rules from a plurality of rules to the word string, wherein each rule is associated with a logic for processing the word string;
- determining whether the word string contains one or more predetermined items;
- and
- if the word string contains one or more predetermined items, for each predetermined item, processing the word string based on the predetermined item.
A computerized auditing method comprising:
- analyzing, using a processor, a word string of an auditable item using one or more analyzing steps, wherein the auditable item is a line item from an insurance claim file;
- and
- using the processor, accepting or rejecting the auditable item based on the analyzing, wherein analyzing the word string comprises:
- applying one or more rules from a plurality of rules to the word string, wherein each rule is associated with a logic for processing the word string;
- determining whether the word string contains one or more predetermined items;
- and
- if the word string contains one or more predetermined items, for each predetermined item, processing the word string based on the predetermined item.
A computerized auditing method comprising:
- analyzing, using a processor, an auditable item using one or more analyzing steps, wherein the auditable item represents a line item from an insurance claim file;
- and
- using a processor, accepting or rejecting the auditable item based on the analyzing;
- wherein analyzing the auditable item comprises:
- applying one or more rules from a plurality of rules to the auditable item, wherein each rule is associated with a logic for processing the auditable item;
- determining whether the auditable item contains one or more predetermined items;
- and
- if the auditable item contains one or more predetermined items, for each predetermined item, processing the auditable item based on the predetermined item.
Dependencies are inferred from the claim text.