| 摘要 |
A method for determining the legitimacy of an insurance claim includes the steps of receiving codes that identify a service for which payment is requested from an insurance provider. Services that might have been upcoded or miscoded to the claimed service are also identified. An insured, a patient or a family member or care giver can be queried about the occurrence of observable aspects of the service that is billed as well as a service that might have been upcoded to what is billed. Responses to the queries suggest the legitimacy or illegitimacy of the claim.
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