Optum, Inc.

Change Healthcare Holdings, LLC

Chenda Deng

Feili Yu

Bo Han

Lei Qi

Alex Londeree

Wenji Zhang

Lynne Miller Padilla

Wayne Zhang

Saloni Parikh

A method includes receiving a record containing clinical information associated with a patient; processing the record using a first AI model that is trained based on medical term frequency throughout respective ones of a plurality of historical medical records; processing the record using a second AI model that is trained based on medical terms used in encounter portions of the respective ones of the plurality of historical medical records; generating a first recommendation for performing a coding review of the record based on processing the record using the first AI model; generating a second recommendation for performing the coding review of the record based on processing the record using the second AI model; and logically combining the first and second recommendation for performing the coding review to generate a final recommendation for performing the coding review.

Methods, systems, and computer program products for determining whether to review medical records for medical coding

A method includes receiving a record containing first clinical information associated with a first patient; and automatically processing the record using a multi-stage Artificial Intelligence (AI) engine to generate at least one suggested code for one or more portions of the first clinical information; wherein the multi-stage AI engine comprises: a first module configured to detect whether the first clinical information includes any information associated with a second patient or whether the record contains second clinical information associated with a second patient; a second module configured to partition the first clinical information based on encounter; a third module configured to identify the one or more portions of the first clinical information; or a fourth module configured to identify content highlights within the one or more portions of the first clinical information and associate the content highlights with candidate codes, respectively.

Decision support system using an artificial intelligence (AI) framework for suggesting codes for a clinical record for a patient and related methods and computer program products

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Fort Collins, CO, United States of America

Chenda Deng