Accenture Global Services Gmbh

Nicholas Francisco Howell

Leana Rachelle Wallace

Sanjay Mathur

Lisa Marie Henning

Michael Scott Hartley

Rayid Ghani

Zhu-Song Mei

Ajay Kurian Easo

Michael S Irish

Dmitriy Feferman

Laura J Jantzen

Mohit Kumar

Lindsey J Lizardi

Methods and systems for processing claims (e.g., healthcare insurance claims) are described. For example, prior to payment of an unpaid claim, a prediction is made as to whether or not an attribute specified in the claim is correct. Depending on the prediction results, the claim can be flagged for an audit. Feedback from the audit can be used to update the prediction models in order to refine the accuracy of those models.

Claims analytics engine

A payment integrity system that processes data, including data associated with a biometric technology. The system includes a discovery module to receive insurance records from a source of data, which includes the data associated with the biometric technology, the records providing information that pertain to at least one transaction. The discovery module includes a query component and an artificial intelligence engine to process the records to identify a second subset of the records having anomalous information, and provide a second analysis output indicative of the second subset. The system also includes an audit module to determine whether to instruct the artificial intelligence engine to analyze the records according to the outputs. The system facilitates resolution of a claim payment based on the first analysis output and the second analysis output.

Advanced data integrity

Methods and systems for identifying and resolving payment integrity issues are provided. Analytic techniques that may include a query component, an artificial intelligence engine, and a text mining component are integrated into a payment integrity system. One or more of the analysis components provide information from a source transaction system to an audit module. The audit module utilizes the outputs from the analysis components to resolve whether or not a claim payment was overpaid or underpaid. The audit module may subsequently instruct one of the analysis components to further analyze information from the source transaction system in accordance with previously provided information from another analysis component.

Advanced insurance record audit and payment integrity

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San Marino, CA, United States of America

Nicholas Francisco Howell