| 摘要 |
A system and method for a rules-based pre-adjudication of a benefits claim submission is disclosed, wherein a patient claim benefit is pre-adjudicated in accordance with proprietary and commercial rules prior to submission to a policy issuing company to assure compliance with the terms and conditions of the patient benefit plan and to minimize error and maximize benefit reimbursement. Treatment plans are generated by examining treatments and conditions codes to arrive at appropriate treatment plans that identify other applicable treatments and conditions codes.
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