Method of increasing efficiency in a medical claim transaction, and computer program capable of executing same

Patent №

US 10,289,804

Granted

2019-05-14

Filed 2004

Owner

TRIZETTO CORPORATION

Lab

AI components

1

planning

Assignment

Recorded

Dataset

AIPD

2023_r1 edition

Application

11018189

A method of adjudicating a medical claim includes providing a requirements for a first claim and a second claim, receiving a medical claim for a medical procedure, setting a first score for the first claim and a second score for the second claim to an initial value, comparing components of the medical claim to the requirements of the first and second claims, changing the first and second scores for each one of the components that match one of the requirements and for each one of the requirements that is missing from the components, and selecting the first or second claim based upon predetermined criteria applied to their respective scores to determine either a monetary value of the medical procedure for a medical service provider associated with the medical procedure or a monetary value of medical coverage for a patient associated with the medical procedure.

PlanningG16H 40/67G06Q 10/10G06Q 40/02G06Q 40/08G16H 40/20

AI classification

Planning1.00
Knowledge representation0.49
AI hardware0.08
Natural language0.02
Vision0.01
Evolutionary computation0.00
Machine learning0.00
Speech0.00

Ownership

TRIZETTO CORPORATION

assignment · 304620885

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