Automated processing of provider billings

摘要

The inclusion of computer capability to process Workers' Compensation claims wherein a complexity of administrative rules determine maximum allowable benefits, the processing of which is not feasible for manual processing. The rules are converted to computer computations entered into the computer's memory. A computer process is devised to systematically examine the rules as they apply to a specific billing. In particular, the various modifiers that affect the allowable pay out are determined through this computer processing. Pre-stored information on prior billings for the same injury is considered for further modification of the allowable billing amount.