Cerner Innovation, Inc.

James L Poteet, Iii

Roma Kumari

Vidya N V

Raymond Glen Delano, Iii

Venkata Negeswara Rao Desaraju

Pogaku Shahazad

Mandar Vijay Kulkarni

Sparsha Shetty

Julie Ann Jensen

Venkata Nageswara Rao Desaraju

Poagaku Shahazad

Vidya Nv

Systems and methods for providing a financial/clinical data interchange are provided. The financial/clinical data interchange provides a distributed implementation to a secure hash key (i.e., a token) and value pair data derived from a medical claim (e.g., patient identification, submitter identification, payer identification, encounter identification, and the like) and enriched with submitter-based domain data. The token may be used as a data attribute in an API that unlocks a pointer to the value (e.g., a fast healthcare interoperability resources (FHIR) uniform resource identifier (URI) to the patient encounter associated with the claim) to leverage a FHIR query for all documented medical records associated with the claim the payer is authorized by the submitter to view.

Providing a financial/clinical data interchange

Methods, computer systems, and computer storage media are provided for utilizing machine learning to predict health plans. A machine learning model is trained to predict valid combinations of employer-payer-health plan in response to one or more missing identifiers based on transaction data from electronic data interchange (EDI) insurance transactions that include valid combinations of employer identifier, payer identifier, and health plan identifier. In response to a request to identify a valid combination based on at least one missing identifier, at least one known identifier corresponding to an employer name, a payer name, or a health plan name is inputted and work location data associated with a patient. The machine learning model generates and displays on a user interface, a predicted set of one or more valid combinations of employer-payer-health plans that correspond to the one known identifier and the work location information that is inputted.

Machine learning model for predicting health plans based on missing input data

Systems and methods for providing a rapid hyperledger onboarding platform are provided. The rapid hyperledger onboarding platform enables various teams within an organization to have their own distributed ledger implementation with a private channel for communication among participants of that network. After a request is received from one or more clients to register an application with a distributed ledger comprising a peer node for each of the one or more clients, a selection of data elements to be stored in the distributed ledger is received. The application is instantiated on the distributed ledger. A separate channel is automatically created for each client of the one or more clients among the corresponding peer nodes. Each channel provides smart contract code execution for the application such that blocks are replicated to a node corresponding to a particular transaction and not to other peer nodes.

Rapid hyperledger onboarding platform

Methods, computer systems, and computer storage media are provided for utilizing machine learning to verify payers and/or health plans. HIPAA transactions can be utilized to train a machine learning model to intelligently link payers and/or health plans to specific employers. Initially, transaction data is received from electronic data interchange (EDI) insurance transactions. The transaction data comprises data corresponding to a plurality of employers, a plurality of payers, and a plurality of health plans provided by the plurality of payers. A machine learning model is trained with the transaction data to build a mapping of the plurality of employers, the plurality of payers contracted with each employer of the plurality of employers, and the plurality of health plans provided by the plurality of payers for each employer of the plurality of employers. The machine learning model is utilized to verify the scan data is mapped in accordance with the mapping.

Intelligently linking payer/health plan combinations to specific employers

Growing community of inventors

Overland Park, KS, United States of America

James L Poteet, Iii