Medical Claims Processing
Automatically match billable activities with the medical necessities and the recommendations of regulators. Provide tooling for expert curation and validation of automatically extracted information.
How you’ll benefit
Automatically collect and keep up-to-date referential medical guidelines and treatment procedures from trusted medical information sources.
Formalize the information in medical guidelines and treatment procedures into any preferred terminology.
Define efficient medical consistency rules that support the automatic claim review process.
Provide tooling for expert curation and validation of automatically extracted information.
How it works
Take advantage of trusted medical sources
- Support for major regulatory approved data sources for prescription drugs and medical treatment information – HCPCS, NCD, LCD, NLM NIH DailyMed and CPT
- Easily add new sources and map them to the currently supported data.
Automatically pre-process and extract highly accurate structured information about:
- Prescription drugs (including administration routes and package forms).
- Indications (described with both medical codes and narratives).
- Recommended treatment (administration amount and form, up-take regime, treatment duration, population group in scope, co-treatment drug).
Create a knowledge graph and a medical rules library
- Use all extracted and semantically normalized data to populate the knowledge graph.
- Employ efficient medical consistency rule definition to support claim review process.
- Generate a library of clinical policy rules that can be used in an automated claims validation process.
See it in action
Discover how to automatically match billable activities with the medical necessities and the recommendations of regulators with Ontotext’s Medical Claims Processing Solution.
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