Making sense of healthcare benefits

ICSE, pp. 1034-1043, 2012.

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Keywords:
benefits administration workflowsystems forces payerbenefit planadjudication systembenefit informationMore(14+)

Abstract:

A key piece of information in healthcare is a patient's benefit plan. It details which treatments and procedures are covered by the health insurer (or payer), and at which conditions. While the most accurate and complete implementation of the plan resides in the payer's claims adjudication systems, the inherent complexity of these system...More

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