60 patents
Utility
Selection of health care data storage policy based on historical data storage patterns and/or patient characteristics using an artificial intelligence engine
9 Jan 24
A method includes defining a plurality of data storage policies, each of the plurality of data storage policies providing rules for storing data among a plurality of data storage locations, each of the plurality of data storage locations having a data storage cost and a data retrieval cost associated therewith; determining a baseline policy distribution among the plurality of data storage policies for an entity; receiving new data items corresponding to the entity; storing the new data items in the plurality of data storage locations using the plurality of data storage policies based on the baseline policy distribution; and determining, using the artificial intelligence engine, a selected one of the plurality of data storage policies to use in storing the new data items corresponding to the entity based on the data storage cost for each of the plurality of data storage locations, and the data retrieval cost for each of the plurality of storage locations.
Philippe Raffy, Jean-Francois Pambrun, David Dubois, Ashish Kumar
Filed: 15 Jan 21
Utility
Medical Claim Denial Prediction Using an Artificial Intelligence Prediction Engine Including a Hybrid Decision Tree
5 Oct 23
A method includes receiving a medical claim for payment by a payor; and using an artificial intelligence engine to predict whether the medical claim will be denied by the payor, the artificial intelligence engine comprising a decision tree having at least one level, such that each of the at least one level has a split function associated therewith corresponding to one of a plurality of features associated with the medical claim; wherein a node in the decision tree terminates when at least one of a plurality of termination criteria are satisfied.
Max Zhao, Shounak Datta, Ting-yu Ho, Vallabha Jagdish, Feili Yu
Filed: 29 Mar 22
Utility
Methods, Systems and Computer Program Products for Making Payment Recommendations for Health Care Claim Lines Having Date Spans
5 Oct 23
A method includes receiving a first claim line identifying a first time span and a first quantity of a health care service provided, and a second claim line identifying a second time span and a second quantity of the health care service provided; determining whether the quantity of health care service provided during the first time span exceeds a maximum amount for a predefined time period; generating a payment recommendation for the first claim line; determining whether a beginning date of the second time span is within the predefined time period and, if so, extending the predefined time period past an ending date of the second time span and generating a payment recommendation for the second claim line in response to determining whether the quantity in the first and second claim lines exceeds a maximum amount for the extended time period.
Tracy Ann WEBER, Daniel LICHVAR, Rama ATLURI, Jennifer BEHM, Prasanth VIJAYAKUMAR, Sasidharan KRISHNAKUMAR, Khemlall MANGAL, Jay PATEL, Julissa CANALES, Elena BUKAREVA
Filed: 30 Mar 22
Utility
Methods, Systems, and Computer Program Products for Staged Onboarding of New Hires to an Organization
31 Aug 23
A method includes defining a plurality of sequential stages for transitioning an individual from a candidate status to an onboarded status of an organization, each one of the plurality of sequential stages having one or more tasks associated therewith, such that completion of the one or more tasks associated with a preceding one of the plurality of sequential stages is required before performing the one or more tasks associated with a current one of the plurality of sequential stages; tracking completion of the one or more tasks for each one of the plurality of sequential stages; and automatically notifying, on a periodic basis, a supervising entity of which one of the sequential stages the individual is currently in based on tracking completion of the one or more tasks for each one of the plurality of sequential stages.
Ravi Botla, Erin Cornelius
Filed: 25 Feb 22
Utility
Event prediction based on medical service and provider information using an artificial intelligence prediction engine
8 Aug 23
A method includes receiving information associated with a stimulus, the information associated with the stimulus comprising first information associated with a medical claim for services provided to a patient and second information associated with a provider that provided the services to the patient; and predicting, using an artificial intelligence engine, when an event will occur in response to the stimulus.
Christopher Mayer, Balaji Lakshmi Ramakrishnan
Filed: 30 Sep 20
Utility
Methods, Systems, and Computer Program Products for Generating a Provider Referral Recommendation Based on a Multi-factor Referral Success Metric
20 Jul 23
A method includes receiving first information associated with a patient, the first information including a procedure or treatment that is recommended for the patient; and generating a list of provider candidates for referring to the patient based on the first information associated with the patient, the list of provider candidates being ranked based on a multi-factor referral success metric.
Jonathan Watters
Filed: 18 Jan 22
Utility
Multi-domain Question Answering System Providing Document Level Inference and Related Methods and Computer Program Products
4 May 23
A method includes discarding a current knowledge corpus; selecting a new knowledge corpus; performing operations as follows using an Artificial Intelligence (Al) retriever engine: dividing the new knowledge corpus into a plurality of sub-documents; encoding a query for the plurality of sub-documents using a query encoding model; encoding each of the plurality of sub-documents using a document encoding model; and determining at least one matching sub-document of the plurality of sub-documents that is a match for containing an answer to the query based on the encoded query and each of the plurality of encoded sub-documents; performing operations as follows using an AI reader engine: generating an inference about the answer to the query based on a concatenation of each of the at least one matching sub-document with the query, each of the at least one matching sub-document having an associated reader loss function result for the inference; identifying one of the at least one matching sub-document having a lowest reader loss function result; and associating the identified one of the at least one matching sub-document with a truth label for the query.
Alex Londeree
Filed: 29 Oct 21
Utility
Methods, Systems, and Computer Program Products for Automatically Processing a Clinical Record for a Patient to Detect Protected Health Information (Phi) Violations
30 Mar 23
A method includes receiving a record including at least one page and containing clinical information associated with a first patient; receiving respective first patient identification values for one or more patient identification parameters corresponding to the first patient; automatically processing the record to identify first example instances referencing the patient identification parameters including values therefor; automatically processing the record to identify second example instances of the first patient identification values; automatically processing the record to determine whether any of the at least one page contained therein cannot be semantically linked to another one of the at least one page in the record; and assigning a grade to each of the at least one page indicating a degree of confidence that the record does not include clinical information associated with a second patient based on the first example instances, the second example instances, and the determination whether any of the at least one page contained therein cannot be semantically linked to another one of the at least one page in the record.
Alex Londeree
Filed: 29 Sep 21
Utility
Methods, Systems, and Computer Program Products for Automatically Selecting a Network Source for Retrieving Clinical Information
30 Mar 23
A method includes receiving a request for clinical information associated with one or more patients from a requestor, the request being associated with requested values for one or more parameters associated with a plurality of network sources for retrieving the clinical information; comparing the requested values with characteristic values for the one or more parameters of each of the plurality of network sources to generate a comparison result; selecting one of the plurality of network sources based on the comparison result; and communicating the request for clinical information to the one of the plurality of network sources that was selected.
Arien Malec, Stephen Dean, Faisal Mushtaq
Filed: 29 Sep 21
Utility
Methods, Systems, and Computer Program Products for Automatically Enriching a Claim with Additional Clinical Information
2 Mar 23
A method includes receiving a claim associated with a patient from a provider; automatically determining whether additional clinical information is needed to adjudicate the claim; automatically retrieving the additional clinical information responsive to determining that the additional clinical information is needed to adjudicate the claim; communicating the claim and the additional clinical information to a payor responsive to determining that the additional clinical information is needed to adjudicate the claim; and communicating the claim to the payor responsive to determining that the additional clinical information is not needed to adjudicate the claim.
Mike Peresie, Ed Hafner
Filed: 26 Aug 21
Utility
Systems and Methods for Increasing Prior Authorization Success Rate for Specialty Drugs
23 Feb 23
A system for increasing the rate of claim approval for specialty drugs is provided.
James Delbert Smith
Filed: 23 Aug 21
Utility
Methods, Systems, and Computer Program Products for Determining Third Party Liability for a Claim
23 Feb 23
A method includes receiving a claim associated with a patient and destined for a first payor from a provider; assessing a likelihood that the first payor is not liable for an entirety of the claim; identifying a second payor responsive to the likelihood that the first payor is not liable for the entirety of the claim exceeding a liability threshold; and routing the claim to the first payor, to the second payor, or to the provider based on routing rules provided by the first payor.
Mike Peresie, Ed Hafner, Cindy Klain
Filed: 23 Aug 21
Utility
METHODS, SYSTEMS, AND COMPUTER PROGRAM PRODUCTS FOR MANAGING RESOURCE CAPACITY USING QUALITY OF SERVICE (QoS) BANDS BASED ON TRANSACTION REQUEST MODELING AND DESTINATION CAPACITY MODELING
9 Feb 23
A method includes generating a payor channel capacity model by modeling a channel capacity between a resource management system and a payor; generating a transaction request model by modeling transaction requests destined for the payor; defining a plurality of Quality of Service (QoS) bands based on the payor channel capacity model and the transaction request model, respective ones of the plurality of QoS bands being indicative of a measure of relative opportunity to establish a connection on the channel between the resource management system and the payor; receiving a current transaction request for the payor at the resource management system; assigning the current transaction request to one of the QoS bands; and establishing a current connection on the channel between the resource management system and the payor to communicate the current transaction request from the resource management system to the payor based on the QoS band assigned to the current transaction request.
Arien Malec, André Viljoen, Cindy Klain, Heather Wilson, Mary Craig, Thomas Cosley, Karen Phillips, Gary Stewart, Chris Compton
Filed: 4 Aug 21
Utility
Systems and methods for automated review of risk adjustment data on submitted medical claims
7 Feb 23
Disclosed and described herein are systems and methods of performing computer-aided analysis of health claims to determine if a current claim is consistent with past claims for a member.
Colleen D'Abbene, William J. O'Neill, Jimmy Liu, David Cardelle
Filed: 28 Mar 19
Utility
Efficient Streaming for Client-side Medical Rendering Applications Based on User Interactions
2 Feb 23
A server-side application is provided that transfers images associated with a medical study.
Jean-Francois Pambrun
Filed: 22 Jul 21
Utility
Methods, Systems, and Computer Program Products for Dynamic Caching and Routing of Health Care Payment Plan Eligibility Responses
5 Jan 23
A method includes maintaining a cache of past responses from a payor to past patient eligibility confirmation requests for one or more payment plans generated by a health care service provider; receiving a present patient eligibility confirmation request from the health care service provider to determine whether a patient is eligible for a payment plan of the one or more payment plans offered by a payor; querying the cache based on demographic information associated with the patient to determine whether the cache has eligibility information for the payment plan for the patient stored therein; selecting a portion of the eligibility information for the payment plan based on health care service provider preferences or payor preferences when the cache has the eligibility information for the payment plan for the patient stored therein; an returning the portion of the eligibility information to the health care service provider.
Arien Malec, Peter Gott, Steven Martin
Filed: 30 Jun 21
Utility
Methods, Systems, and Computer Program Products for Capturing Missing Current Procedural Terminology (CPT) Codes for Care Provided to a Patient
5 Jan 23
A method includes receiving a current claim associated with care provided to a patient by a provider, the claim including a current diagnosis code and a first current procedural terminology (CPT) code that are based on the care that was provided; identifying, using an artificial intelligence (AI) engine, a second current CPT code based on the current diagnosis code and the first current CPT code; and generating a current confidence level value that the second current CPT code is missing from the current claim.
Wenji Zhang, Feili Yu, Kaushik Roy
Filed: 30 Jun 21
Utility
Method and apparatus for refining an automated coding model
3 Jan 23
A method, apparatus and computer program product refine an automated coding model, such as for a medical chart.
Alex Londeree, Nick Giannasi, Adrian Lam, Adam Sullivan
Filed: 29 Mar 19
Utility
Systems and Methods for Improving Health Services
22 Dec 22
A system for health services is provided.
James Bryan Stinnett, IV, Margaret Grace Hoyt, Sabrina Nicole Kates, Katherine Terry Coode, Samuel Becnel Rollenhagen
Filed: 22 Jun 21
Utility
Integrated Patient Acquisition for Virtual Care
22 Dec 22
In an embodiment, a method of interacting with a patient via a virtual triage system and for determining a suggested care path is provided.
Serrah Lynn Linares, Gautam Shah
Filed: 22 Jun 21