SAIF.Business.Claim.Bill.AutomatedAudit overview

Documentation context: Packaged Component (NuGet)

This library is a Business Layer component implementing the automated medical bill auditing engine. It extends the SAIF.BOF.Business.Claim.Bill library with audit-specific logic.

Purpose

• Provides the documented SAIF.Business.Claim.Bill.AutomatedAudit public surface within the claim domain.
• Automated bill auditing — BillAuditEngine.AuditBill() orchestrates the full audit workflow.
• Bill editing — clsBillEditor and clsServiceEditor modify bill/service data during audit.

Responsibilities

• Automated bill auditing — BillAuditEngine.AuditBill() orchestrates the full audit workflow.
• Bill editing — clsBillEditor and clsServiceEditor modify bill/service data during audit.
• Audit calculation — clsAuditCalculator performs payment calculations.
• Audit comparison — clsAuditCompare compares current vs. previous audit data.
• MCO management — clsMCOManager handles managed care organization logic.
• Pharmacy enrollment — clsPharmacyEnrollment validates pharmacy enrollment.

Key components

• BillAuditEngine: Business object — automated bill audit engine/orchestrator
• clsBillAudit: Extended bill object for audit operations
• clsBillAuditService: Data holder — audit service line properties
• AuditTrailManager: Utility — audit trail logging
• clsAuditCalculator: Utility — audit calculation logic
• clsAuditCompare: Utility — comparison logic for audit
• clsBillAuditUtility: Utility — general bill audit utilities
• clsBillAuditor: Orchestrator — performs audit rule application

Related documentation

• Index
• Architecture
• Dependencies
• Operations and processes
• Business rules
• Database tables
• SQL catalog
• API reference

Sources

• Business\SAIF.Business.Claim.Bill.AutomatedAudit\SAIF.BOF.Business.Claim.Bill.AutomatedAudit.vbproj
• Business\SAIF.Business.Claim.Bill.AutomatedAudit\SAIF.BOF.Business.Claim.Bill.AutomatedAudit.nuspec
• Business\SAIF.Business.Claim.Bill.AutomatedAudit\packages.config
• Business\SAIF.Business.Claim.Bill.AutomatedAudit\BillAuditEngine.vb
• Business\SAIF.Business.Claim.Bill.AutomatedAudit\clsBillAudit.vb
• Business\SAIF.Business.Claim.Bill.AutomatedAudit\clsBillAuditService.vb
• Business\SAIF.Business.Claim.Bill.AutomatedAudit\AuditUtilities\clsBillAuditor.vb
• Business\SAIF.Business.Claim.Bill.AutomatedAudit\AuditUtilities\clsBillEditor.vb
• Business\SAIF.Business.Claim.Bill.AutomatedAudit\AuditUtilities\clsServiceEditor.vb
• Business\SAIF.Business.Claim.Bill.AutomatedAudit\AuditUtilities\clsAuditCalculator.vb
• Business\SAIF.Business.Claim.Bill.AutomatedAudit\AuditUtilities\clsMCOManager.vb
• Business\SAIF.Business.Claim.Bill.AutomatedAudit\AuditUtilities\clsPharmacyEnrollment.vb