CN101996385A - 索赔分析引擎 - Google Patents

索赔分析引擎 Download PDF

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Publication number
CN101996385A
CN101996385A CN2010102606465A CN201010260646A CN101996385A CN 101996385 A CN101996385 A CN 101996385A CN 2010102606465 A CN2010102606465 A CN 2010102606465A CN 201010260646 A CN201010260646 A CN 201010260646A CN 101996385 A CN101996385 A CN 101996385A
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attribute
data
audit
model
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Chinese (zh)
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R·格哈尼
L·R·瓦朗斯
M·S·艾里斯
A·K·埃索
M·库玛
Z-S·梅
D·菲弗曼
N·F·霍维尔
L·J·利扎迪
L·J·简特曾
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Accenture Global Services Ltd
Accenture International LLC
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Accenture Global Services GmbH
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    • G—PHYSICS
    • G06—COMPUTING OR CALCULATING; COUNTING
    • G06Q—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES; SYSTEMS OR METHODS SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES, NOT OTHERWISE PROVIDED FOR
    • G06Q40/00—Finance; Insurance; Tax strategies; Processing of corporate or income taxes
    • G06Q40/08—Insurance
    • G—PHYSICS
    • G06—COMPUTING OR CALCULATING; COUNTING
    • G06N—COMPUTING ARRANGEMENTS BASED ON SPECIFIC COMPUTATIONAL MODELS
    • G06N20/00—Machine learning
    • G—PHYSICS
    • G06—COMPUTING OR CALCULATING; COUNTING
    • G06Q—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES; SYSTEMS OR METHODS SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES, NOT OTHERWISE PROVIDED FOR
    • G06Q10/00—Administration; Management
    • G06Q10/10—Office automation; Time management

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  • Business, Economics & Management (AREA)
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  • General Business, Economics & Management (AREA)
  • Marketing (AREA)
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  • Medical Informatics (AREA)
  • Computer Vision & Pattern Recognition (AREA)
  • Artificial Intelligence (AREA)
  • Computing Systems (AREA)
  • General Engineering & Computer Science (AREA)
  • Information Retrieval, Db Structures And Fs Structures Therefor (AREA)
  • Medical Treatment And Welfare Office Work (AREA)
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CN2010102606465A 2009-08-25 2010-08-20 索赔分析引擎 Pending CN101996385A (zh)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US12/547,110 2009-08-25
US12/547,110 US8762180B2 (en) 2009-08-25 2009-08-25 Claims analytics engine

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CN101996385A true CN101996385A (zh) 2011-03-30

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US (2) US8762180B2 (enExample)
EP (1) EP2290608A1 (enExample)
JP (1) JP5586373B2 (enExample)
CN (1) CN101996385A (enExample)
AU (1) AU2010212343B2 (enExample)
CA (1) CA2712849A1 (enExample)
MX (1) MX2010009152A (enExample)

Cited By (15)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN103874999A (zh) * 2011-03-31 2014-06-18 艾斯兰股份有限公司 用于提供对无线装置保护计划的目标实现的方法、设备和计算机程序产品
CN105830073A (zh) * 2013-12-17 2016-08-03 阿提乔有限责任公司 基于从较小数据集计算出的值估计从大数据集得出的值的方法和系统
CN106022892A (zh) * 2016-05-30 2016-10-12 深圳市华傲数据技术有限公司 信用评分模型的更新方法及系统
CN106022912A (zh) * 2016-05-30 2016-10-12 深圳市华傲数据技术有限公司 评价模型的更新方法及系统
CN107871283A (zh) * 2016-09-26 2018-04-03 平安科技（深圳）有限公司 保险理赔的处理方法及装置
CN108230158A (zh) * 2016-12-15 2018-06-29 平安科技（深圳）有限公司 一种理赔测试方法和装置
CN108352035A (zh) * 2015-05-18 2018-07-31 口袋医生公司 用于高效索赔处理的动态拓扑系统和方法
CN109584081A (zh) * 2017-09-28 2019-04-05 埃森哲环球解决方案有限公司 用于处理数据的系统和方法
CN109636632A (zh) * 2018-12-13 2019-04-16 平安医疗健康管理股份有限公司 基于机器学习的保险理赔方法、装置、设备及存储介质
CN109829150A (zh) * 2018-11-27 2019-05-31 阿里巴巴集团控股有限公司 保险理赔文本处理方法及装置
CN110020770A (zh) * 2017-12-27 2019-07-16 埃森哲环球解决方案有限公司 基于人工智能的风险和知识管理
CN110134939A (zh) * 2018-02-02 2019-08-16 埃森哲环球解决方案有限公司 基于本体和规则的裁决
CN113228077A (zh) * 2018-12-27 2021-08-06 未来集团股份有限公司 在协调响应于在政策下进行承保的请求的服务和/或支付中用于自动质量管理和识别错误、遗漏和/或偏差的系统、方法和平台
CN114926184A (zh) * 2021-02-02 2022-08-19 华晨宝马汽车有限公司 优化索赔成本回收过程的方法、系统和设备
CN117541171A (zh) * 2023-10-23 2024-02-09 河北智汇邢网络科技有限公司 一种基于区块链的信息处理方法及系统

Families Citing this family (39)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US8315888B2 (en) * 2010-02-12 2012-11-20 Assets Quest, Inc. Method and system for estimating unpaid claims
US20110246262A1 (en) * 2010-04-02 2011-10-06 QMedtrix Systems, Inc. Method of classifying a bill
US10002391B1 (en) * 2010-10-11 2018-06-19 Pionetechs, Inc. Method for detecting and preventing fraudulent healthcare claims
US9026551B2 (en) * 2013-06-25 2015-05-05 Hartford Fire Insurance Company System and method for evaluating text to support multiple insurance applications
US9626432B2 (en) * 2013-09-09 2017-04-18 International Business Machines Corporation Defect record classification
US9984421B2 (en) * 2014-09-05 2018-05-29 Hartford Fire Insurance Company System for claim data segmentation
EP3018602A3 (en) * 2014-11-10 2016-07-20 Accenture Global Services Limited Medical coding management system using an intelligent coding, reporting, and analytics-focused tool
US10204703B2 (en) 2014-11-10 2019-02-12 Accenture Global Services Limited Medical coding management system using an intelligent coding, reporting, and analytics-focused tool
US11244401B2 (en) 2015-10-30 2022-02-08 Hartford Fire Insurance Company Outlier system for grouping of characteristics
US10942929B2 (en) 2015-10-30 2021-03-09 Hartford Fire Insurance Company Universal repository for holding repeatedly accessible information
US10628456B2 (en) 2015-10-30 2020-04-21 Hartford Fire Insurance Company Universal analytical data mart and data structure for same
JP6593231B2 (ja) * 2016-03-14 2019-10-23 富士通株式会社 レセプト電算ファイル作成プログラム、レセプト電算ファイル作成装置及びレセプト電算ファイル作成方法
CN107766929B (zh) * 2017-05-05 2019-05-24 平安科技（深圳）有限公司 模型分析方法及装置
US20210287297A1 (en) * 2017-09-27 2021-09-16 State Farm Mutual Automobile Insurance Company Automobile Monitoring Systems and Methods for Loss Reserving and Financial Reporting
KR101974521B1 (ko) * 2017-11-29 2019-05-07 (주)위세아이텍 인공지능 기반의 보험금 부당청구 탐지 장치 및 방법
US20190279306A1 (en) * 2018-03-09 2019-09-12 Cognizant Technology Solutions India Pvt. Ltd. System and method for auditing insurance claims
JP7198001B2 (ja) * 2018-06-06 2022-12-28 株式会社日立製作所 判定装置、判定方法
US11538112B1 (en) * 2018-06-15 2022-12-27 DocVocate, Inc. Machine learning systems and methods for processing data for healthcare applications
US11270156B2 (en) 2018-06-28 2022-03-08 Optum Services (Ireland) Limited Machine learning for dynamically updating a user interface
US11636455B2 (en) * 2018-07-12 2023-04-25 Inbox Health Corp. Intelligent patient billing communication platform for health services
CN110858214B (zh) * 2018-08-22 2022-07-05 北京国双科技有限公司 推荐模型训练、及进一步审计程序推荐方法、装置及设备
US20200111054A1 (en) * 2018-10-03 2020-04-09 International Business Machines Corporation Automated claims auditing
KR102605458B1 (ko) * 2018-10-05 2023-11-22 텔레폰악티에볼라겟엘엠에릭슨(펍) 분석 기능 발견 방법 및 장치
JP6743116B2 (ja) * 2018-12-25 2020-08-19 みずほ情報総研株式会社 審査支援システム、審査支援方法及び審査支援プログラム
CN109919780B (zh) * 2019-01-23 2024-07-09 平安科技（深圳）有限公司 基于图计算技术的理赔反欺诈方法、装置、设备及存储介质
JP2020129295A (ja) * 2019-02-08 2020-08-27 富士通株式会社 情報処理プログラム、情報処理装置、及び情報処理方法
US11568397B2 (en) 2019-04-24 2023-01-31 Cerner Innovation, Inc. Providing a financial/clinical data interchange
WO2020241332A1 (ja) * 2019-05-30 2020-12-03 富士フイルム富山化学株式会社 医療情報登録支援装置、医療情報登録支援方法、及びプログラム
US20210133769A1 (en) * 2019-10-30 2021-05-06 Veda Data Solutions, Inc. Efficient data processing to identify information and reformant data files, and applications thereof
US11315196B1 (en) * 2019-12-03 2022-04-26 Data-Core Systems, Inc. Synthesized invalid insurance claims for training an artificial intelligence / machine learning model
US11461361B2 (en) 2019-12-31 2022-10-04 Cerner Innovation, Inc. Rapid hyperledger onboarding platform
US11449359B2 (en) 2020-06-12 2022-09-20 Optum Services (Ireland) Limited Prioritized data object processing under processing time constraints
US20210406246A1 (en) * 2020-06-24 2021-12-30 David Mueller Management of diverse data analytics frameworks in computing systems
US11663552B2 (en) * 2020-12-15 2023-05-30 International Business Machines Corporation Dynamically customizing a workflow separate from domain logic
US20230013443A1 (en) * 2021-07-19 2023-01-19 Chevron U.S.A. Inc. Systems and processes for reconciling field costs
US20230063220A1 (en) * 2021-08-30 2023-03-02 EnableComp, LLC Systems and Methods for Predicting Missing Data Values
US12488063B2 (en) 2021-09-01 2025-12-02 Unitedhealth Group Incorporated Generating input processing rules engines using probabilistic clustering techniques
US12260943B2 (en) 2022-01-27 2025-03-25 Evernorth Strategic Development, Inc. Defection propensity model architecture with adaptive remediation
US20240281886A1 (en) * 2023-02-16 2024-08-22 Forensic Claims Solutions, LLC Inferring and/or predicting relationship rules

Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2001013295A1 (en) * 1999-08-12 2001-02-22 Hnc Software, Inc. Detection of insurance premium fraud or abuse using a predictive software system
US20050108063A1 (en) * 2003-11-05 2005-05-19 Madill Robert P.Jr. Systems and methods for assessing the potential for fraud in business transactions
WO2009073151A1 (en) * 2007-11-28 2009-06-11 Assurant, Inc. Automated claims processing system

Family Cites Families (8)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US8521546B2 (en) * 1998-09-25 2013-08-27 Health Hero Network Dynamic modeling and scoring risk assessment
US7813937B1 (en) * 2002-02-15 2010-10-12 Fair Isaac Corporation Consistency modeling of healthcare claims to detect fraud and abuse
JP4072103B2 (ja) * 2003-07-15 2008-04-09 株式会社日立製作所 診療報酬明細書の審査支援方法、診療報酬明細書の審査支援装置および診療報酬明細書の審査支援装置用プログラム
JP3940126B2 (ja) 2004-02-24 2007-07-04 みずほ情報総研株式会社 審査管理方法及び審査管理プログラム
JP2004355633A (ja) * 2004-05-28 2004-12-16 Hitachi Ltd 診療報酬明細書情報読取り装置および方法ならびにそのプログラム、診療報酬明細書審査支援装置および方法ならびにそのプログラム
EP1836674A4 (en) * 2004-11-16 2009-12-16 Health Dialog Data Service Inc SYSTEMS AND METHODS FOR PREDICTING EVENT RISKS AND FINANCIAL RISK RELATING TO MEDICAL CARE
JP5050504B2 (ja) 2006-11-28 2012-10-17 株式会社日立製作所 再審査実績を用いたレセプト抽出方法及びレセプト点検支援システム
WO2009111287A2 (en) * 2008-02-29 2009-09-11 Crowe Paradis Holding Company Methods ans systems for automated, predictive modeling of the outcome of benefits claims

Patent Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2001013295A1 (en) * 1999-08-12 2001-02-22 Hnc Software, Inc. Detection of insurance premium fraud or abuse using a predictive software system
US20050108063A1 (en) * 2003-11-05 2005-05-19 Madill Robert P.Jr. Systems and methods for assessing the potential for fraud in business transactions
WO2009073151A1 (en) * 2007-11-28 2009-06-11 Assurant, Inc. Automated claims processing system

Cited By (21)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN103874999A (zh) * 2011-03-31 2014-06-18 艾斯兰股份有限公司 用于提供对无线装置保护计划的目标实现的方法、设备和计算机程序产品
US11915197B2 (en) 2011-03-31 2024-02-27 Assurant, Inc. Systems and methods for programmatically weighting disparate inputs to optimize a predictive model
CN105830073A (zh) * 2013-12-17 2016-08-03 阿提乔有限责任公司 基于从较小数据集计算出的值估计从大数据集得出的值的方法和系统
CN108352035A (zh) * 2015-05-18 2018-07-31 口袋医生公司 用于高效索赔处理的动态拓扑系统和方法
CN106022892A (zh) * 2016-05-30 2016-10-12 深圳市华傲数据技术有限公司 信用评分模型的更新方法及系统
CN106022912A (zh) * 2016-05-30 2016-10-12 深圳市华傲数据技术有限公司 评价模型的更新方法及系统
CN107871283A (zh) * 2016-09-26 2018-04-03 平安科技（深圳）有限公司 保险理赔的处理方法及装置
CN108230158A (zh) * 2016-12-15 2018-06-29 平安科技（深圳）有限公司 一种理赔测试方法和装置
CN108230158B (zh) * 2016-12-15 2021-12-03 平安科技（深圳）有限公司 一种理赔测试方法和装置
CN109584081A (zh) * 2017-09-28 2019-04-05 埃森哲环球解决方案有限公司 用于处理数据的系统和方法
CN110020770A (zh) * 2017-12-27 2019-07-16 埃森哲环球解决方案有限公司 基于人工智能的风险和知识管理
CN110134939A (zh) * 2018-02-02 2019-08-16 埃森哲环球解决方案有限公司 基于本体和规则的裁决
CN110134939B (zh) * 2018-02-02 2023-01-13 埃森哲环球解决方案有限公司 基于本体和规则的裁决
US11586955B2 (en) 2018-02-02 2023-02-21 Accenture Global Solutions Limited Ontology and rule based adjudication
CN109829150A (zh) * 2018-11-27 2019-05-31 阿里巴巴集团控股有限公司 保险理赔文本处理方法及装置
CN109829150B (zh) * 2018-11-27 2023-11-14 创新先进技术有限公司 保险理赔文本处理方法及装置
CN109636632A (zh) * 2018-12-13 2019-04-16 平安医疗健康管理股份有限公司 基于机器学习的保险理赔方法、装置、设备及存储介质
CN113228077A (zh) * 2018-12-27 2021-08-06 未来集团股份有限公司 在协调响应于在政策下进行承保的请求的服务和/或支付中用于自动质量管理和识别错误、遗漏和/或偏差的系统、方法和平台
CN113228077B (zh) * 2018-12-27 2023-09-19 未来集团股份有限公司 在协调响应于在政策下进行承保的请求的服务和/或支付中用于自动质量管理和识别错误、遗漏和/或偏差的系统、方法和平台
CN114926184A (zh) * 2021-02-02 2022-08-19 华晨宝马汽车有限公司 优化索赔成本回收过程的方法、系统和设备
CN117541171A (zh) * 2023-10-23 2024-02-09 河北智汇邢网络科技有限公司 一种基于区块链的信息处理方法及系统

Also Published As

Publication number Publication date
MX2010009152A (es) 2011-03-11
JP2011048822A (ja) 2011-03-10
EP2290608A1 (en) 2011-03-02
US8762180B2 (en) 2014-06-24
US20140249865A1 (en) 2014-09-04
US20110054925A1 (en) 2011-03-03
JP5586373B2 (ja) 2014-09-10
AU2010212343A1 (en) 2011-03-17
AU2010212343B2 (en) 2012-04-12
CA2712849A1 (en) 2011-02-25

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