Making sense of healthcare benefits


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 payerâ s claims adjudication systems, the inherent complexity of these systems forces payers to maintain multiple repositories of benefit information for other service and regulatory needs. In this paper we present a technology that deals with this complexity. We show how a large US health payer benefited from using the visualization, search, summarization and other capabilities of the technology. We argue that this technology can be used to improve productivity and reduce error rate in the benefits administration workflow, leading to lower administrative overhead and cost for health payers, which benefits both payers and patients.

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@article{Bnayahu2012MakingSO, title={Making sense of healthcare benefits}, author={Jonathan Bnayahu and Maayan Goldstein and Mordechai Nisenson and Yahalomit Simionovici}, journal={2012 34th International Conference on Software Engineering (ICSE)}, year={2012}, pages={1034-1043} }