Optum, Inc.

Michael J DeTolla

Mark L Morsch

Kelly Hogan

Lisa Dianne Rose

Kelly Kay Romsdahl

Nancy E Morden

David J Falk

Paul C Van Fossan

Troy C Lacher

Chad L Hilton

Tanya A Hendrickson

Various embodiments of the present disclosure provide methods, apparatuses, systems, devices, computing entities for evaluating a medical encounter between a healthcare provider and a patient. Various embodiments evaluate a medical encounter to determine a classification of the medical encounter. An example method comprises receiving a claim data object comprising a plurality of code portions, each code portion corresponding to a dimension of the medical encounter; processing the claim data object to extract a plurality of code character strings, each code character string extracted from a corresponding code portion of the claim data object; generating a claim classification for the claim data object based at least in part on evaluating the plurality of code character strings with respect to at least one dimension relating to the provider's contribution to the encounter and at least one dimension relating to the patient's contribution to the encounter; and performing at least one classification-based action.

Multi-dimensional evaluations for the classification of data objects

Embodiments of the present disclosure provide for improved determination of complexities associated with event data objects. Such complexity determinations may be identified based at least in part on complexity score(s) generated from any number of augmented event codes. Embodiments identify augmented event codes from any of a myriad of sources, including various service encodings and participant history profiles for particular event entities. The augmented event codes may be processed in a myriad of ways, utilizing the entirety and/or portions thereof, to further enhance the accuracy of the event complexity determined therefrom. Based at least in part on the accurately generated complexity determination(s), one or more prediction-based actions may be initiated that correspond to the particular complexity determination(s), for example such that only the correct prediction-based action is initiated based at least in part on such a determined event complexity.

Apparatuses, computer-implemented methods, and computer program products for accurate data code processing utilizing augmented data codes

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Bainbridge Island, WA, United States of America

Michael J DeTolla