A claims review engine which will allow the scheme operator to define the various conditions for the automatic acceptance/rejection of a claim is deemed necessary to make the claim review processes more efficient. It would build on the current automated checks applied on claims during submission, to include conditionality based on additional factors around beneficiary, product, services, and item definition. This engine is expected to allow users to enter multiple of 'rules,' which would have various trigger conditions, but would have an action of either rejecting, accepting or flagging (fully/partially) claims.
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