AUTOMATION OF AUDITING CLAIMS
Described are computer-based methods and apparatuses, including computer program products, for automation of auditing claims. A data file is received comprising one or more auditable items, each auditable item comprising a word string having one or more words. Each word string for each auditable item is translated using one or more translation steps into a translated item description. Each translated item description is compared to a plurality of terms to generate matching information. Each translated item description is associated with an item identifier based on the matching information. Each auditable item is accepted or rejected based on the item identifier and one or more rules associated with the data file.
1 - 37 . (canceled)
38 . A computerized auditing method comprising:
translating, using a processor, a word string of an auditable item using one or more translation steps into a translated item description, wherein the auditable item is a line item from an insurance claim file; and
using a processor, automatically accepting or automatically rejecting the auditable item based on the translating, wherein translating the word string comprises:
applying one or more rules from a plurality of rules to the word string, wherein each rule is associated with a logic for processing the word string;
determining whether the word string contains one or more predetermined items; and
if the word string contains one or more predetermined items, for each predetermined item, processing the word string based on the predetermined item.
39 . The method of claim 38 further comprising a processor preparing an approved estimate for the insurance claim file in response to said accepting or rejecting.
40 . The method of claim 38 wherein the insurance claim file is a vehicle insurance claim file.
41 . The method of claim 38 wherein the insurance claim file is a medical insurance claim file.
42 . The method of claim 38 wherein the insurance claim file is a property insurance claim file.
43 . The method of claim 38 further comprising: using a processor, automatically preparing an estimate for the insurance claim file responsive to determining availability of a part indicated in the line item.
44 . The method of claim 38 wherein the auditable item indicates a vehicle part and the accepting or rejecting is responsive to checking a database for availability of a part corresponding to the vehicle part indicated in the auditable item.
45 . A computerized auditing method comprising:
analyzing, using a processor, a word string of an auditable item using one or more analyzing steps, wherein the auditable item is a line item from an insurance claim file; and
using the processor, accepting or rejecting the auditable item based on the analyzing, wherein analyzing the word string comprises:
applying one or more rules from a plurality of rules to the word string, wherein each rule is associated with a logic for processing the word string;
determining whether the word string contains one or more predetermined items; and
if the word string contains one or more predetermined items, for each predetermined item, processing the word string based on the predetermined item.
46 . The method of claim 45 wherein the analyzing is responsive to determining a point of impact of a damaged vehicle.
47 . The method of claim 45 further comprising rejecting the auditable item.
48 . The method of claim 47 further comprising automatically preparing an estimate for the insurance claim file responsive to rejecting the auditable item.
49 . A computerized auditing method comprising:
analyzing, using a processor, an auditable item using one or more analyzing steps, wherein the auditable item represents a line item from an insurance claim file; and
using a processor, accepting or rejecting the auditable item based on the analyzing;
wherein analyzing the auditable item comprises:
applying one or more rules from a plurality of rules to the auditable item, wherein each rule is associated with a logic for processing the auditable item;
determining whether the auditable item contains one or more predetermined items; and
if the auditable item contains one or more predetermined items, for each predetermined item, processing the auditable item based on the predetermined item.
50 . The method of claim 49 further comprising rejecting the auditable item.
51 . The method of claim 50 further comprising automatically preparing an estimate for the insurance claim file responsive to rejecting the auditable item.
52 . The method of claim 51 wherein the auditable item indicates a replacement part and rejecting the auditable item is responsive to checking a historical parts database for availability of the replacement part on a date associated with the insurance claim file.
53 . The method of claim 49 wherein the analyzing is responsive to determining a point of impact of a damaged vehicle.
54 . The method of claim 49 wherein the insurance claim file is a vehicle insurance claim file.
55 . The method of claim 49 wherein the insurance claim file is a medical insurance claim file.
56 . The method of claim 49 wherein the auditable item indicates an operational item.
57 . The method of claim 49 further comprising: using a processor, automatically preparing an estimate for the insurance claim file responsive to analyzing a part indicated in the auditable item.
58 . The method of claim 49 wherein the auditable item indicates a vehicle part and the accepting or rejecting is responsive to checking a database for availability of a part corresponding to the vehicle part indicated in the auditable item.