Methodology for Structuring MLE Regulations and Its Automatic Review in Medical Accounts

In this work, we propose a method for the automatic review of Chilean medical accounts. The medical bills are governed by the Free Choice Modality and Tariff Regulations (by its Spanish acronym MLE). We present a methodology for structuring the regulations so that the algorithm can validate compliance with the regulations in a medical account. The rules are structured using an Excel file containing information such as the code, description, type, and group of each rule. A subset of the Regulations was selected, which was structured with the proposed methodology. To test the compliance of a medical account in PDF format, an algorithm written in Python reads the file and identifies the information of each service. Compliance with these regulations was evaluated in a set of simulated medical accounts. The results showed the proper functioning of the algorithm, in much less time than the current method of reviewing medical accounts. Furthermore, the methodology enables an easy update of the MLE versions.