发明名称 |
Novel Method and Apparatus For Repricing a Reimbursement Claim Against a Contract |
摘要 |
A method for repricing a reimbursement claim under at least one contract is provided herein. The method may include a combination of steps such as: converting each contract into a series of contractual terms; converting a claim into a series of claim lines, containing claim codes, unit numbers and corresponding charges for the claim codes; comparing claim codes and contractual terms and identifying matches therebetween; determining any priority conditions associated to the matching contractual terms, and eliminate any matching contractual terms that are excluded by the priority conditions; calculating the reimbursement amount for the claim by determining the reimbursement charges for the non-excluded matching contractual terms; and determining and making any adjustments depending upon any discount terms for the entire reimbursement amount.
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申请公布号 |
US2013144648(A1) |
申请公布日期 |
2013.06.06 |
申请号 |
US201213709141 |
申请日期 |
2012.12.10 |
申请人 |
THE TRIZETTO GROUP, INC.;THE TRIZETTO GROUP, INC. |
发明人 |
LESSWING MARK;HOERLE DALE |
分类号 |
G06Q50/22;G06Q10/00 |
主分类号 |
G06Q50/22 |
代理机构 |
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代理人 |
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主权项 |
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地址 |
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