Importance

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Abstract

An automated health benefit processing system. The system includes a database and three processors. The database includes, for each geographic area and for each medical procedures for which a benefit is payable, the benefit payable to an insured if the procedure is prescribed and performed, a list of providers available to perform the designated procedure, and each provider's charge for performing the designated procedure. The first processor generates a treatment plan concerning the insured that specifies the identity of the insured and the medical procedures to be performed on the insured. The first processor also accesses the database to retrieve the information stored in the database under the medical procedures to be performed and to append this information to the treatment plan. The second processor generates a treatment record specifying the medical procedures actually performed by a provider and the provider's actual charge therefor. The third processor processes the information in the treatment plan and treatment records to determine amounts payable to the insured and the provider.

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First Claim