CN101996385A - 索赔分析引擎 - Google Patents
索赔分析引擎 Download PDFInfo
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- 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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- G—PHYSICS
- G06—COMPUTING; CALCULATING OR 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
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- G—PHYSICS
- G06—COMPUTING; CALCULATING OR COUNTING
- G06N—COMPUTING ARRANGEMENTS BASED ON SPECIFIC COMPUTATIONAL MODELS
- G06N20/00—Machine learning
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- G—PHYSICS
- G06—COMPUTING; CALCULATING OR 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
Abstract
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Claims (15)
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 |
Publications (1)
Publication Number | Publication Date |
---|---|
CN101996385A true CN101996385A (zh) | 2011-03-30 |
Family
ID=42827395
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
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CN2010102606465A Pending CN101996385A (zh) | 2009-08-25 | 2010-08-20 | 索赔分析引擎 |
Country Status (7)
Country | Link |
---|---|
US (2) | US8762180B2 (zh) |
EP (1) | EP2290608A1 (zh) |
JP (1) | JP5586373B2 (zh) |
CN (1) | CN101996385A (zh) |
AU (1) | AU2010212343B2 (zh) |
CA (1) | CA2712849A1 (zh) |
MX (1) | MX2010009152A (zh) |
Cited By (14)
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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 |
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 |
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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 |
US10217170B2 (en) * | 2014-09-05 | 2019-02-26 | Hartford Fire Insurance Company | System for claim load balancing |
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 |
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 |
US10942929B2 (en) | 2015-10-30 | 2021-03-09 | Hartford Fire Insurance Company | Universal repository for holding repeatedly accessible information |
US11244401B2 (en) | 2015-10-30 | 2022-02-08 | Hartford Fire Insurance Company | Outlier system for grouping of characteristics |
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 |
US10497250B1 (en) * | 2017-09-27 | 2019-12-03 | State Farm Mutual Automobile Insurance Company | Real property monitoring systems and methods for detecting damage and other conditions |
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 |
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 |
CN109919780A (zh) * | 2019-01-23 | 2019-06-21 | 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 |
JP7268148B2 (ja) * | 2019-05-30 | 2023-05-02 | 富士フイルム富山化学株式会社 | 医療情報登録支援装置、医療情報登録支援装置の作動方法、及びプログラム |
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 |
Citations (3)
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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 |
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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 |
AU2005307823B2 (en) * | 2004-11-16 | 2012-03-08 | Health Dialog Services Corporation | Systems and methods for predicting healthcare related risk events and financial risk |
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 |
-
2009
- 2009-08-25 US US12/547,110 patent/US8762180B2/en active Active
-
2010
- 2010-08-10 CA CA2712849A patent/CA2712849A1/en not_active Abandoned
- 2010-08-10 JP JP2010179764A patent/JP5586373B2/ja active Active
- 2010-08-12 EP EP10008444A patent/EP2290608A1/en not_active Ceased
- 2010-08-13 AU AU2010212343A patent/AU2010212343B2/en active Active
- 2010-08-19 MX MX2010009152A patent/MX2010009152A/es unknown
- 2010-08-20 CN CN2010102606465A patent/CN101996385A/zh active Pending
-
2014
- 2014-05-16 US US14/280,065 patent/US20140249865A1/en not_active Abandoned
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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 (20)
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 |
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 |
---|---|
US20140249865A1 (en) | 2014-09-04 |
AU2010212343A1 (en) | 2011-03-17 |
AU2010212343B2 (en) | 2012-04-12 |
EP2290608A1 (en) | 2011-03-02 |
JP2011048822A (ja) | 2011-03-10 |
US20110054925A1 (en) | 2011-03-03 |
MX2010009152A (es) | 2011-03-11 |
JP5586373B2 (ja) | 2014-09-10 |
US8762180B2 (en) | 2014-06-24 |
CA2712849A1 (en) | 2011-02-25 |
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