发明名称 |
Rule-based Prediction of Medical Claims' Payments |
摘要 |
Some embodiments of the present invention evaluate claim submissions. Prediction(s) are generated that employ machine learning engine(s) and/or expert models executing on processor(s). The prediction(s) may forecast if claim data when submitted to a payer will result in at least one of the following: an approved submission; a denied submission; and an apparent payment variation. The machine learning engine(s) may be updated using use the prediction. Labeled data may be generated by classifying patient claim data residing in a database of claim records and histories with at least one of the following: an anomaly detection label; a contract based label; and a combination of the above. Claims classification model(s) may be trained using the labeled data. Predictive paid amount model(s) may be created that employ at least the labeled data and/or an amount paid on a claim. |
申请公布号 |
US2013054259(A1) |
申请公布日期 |
2013.02.28 |
申请号 |
US201213401942 |
申请日期 |
2012.02.22 |
申请人 |
WOJTUSIAK JANUSZ;SHIVER JOHN M. |
发明人 |
WOJTUSIAK JANUSZ;SHIVER JOHN M. |
分类号 |
G06Q50/22;G06Q10/00 |
主分类号 |
G06Q50/22 |
代理机构 |
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代理人 |
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主权项 |
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地址 |
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