The patent badge is an abbreviated version of the USPTO patent document. The patent badge does contain a link to the full patent document.
The patent badge is an abbreviated version of the USPTO patent document. The patent badge covers the following: Patent number, Date patent was issued, Date patent was filed, Title of the patent, Applicant, Inventor, Assignee, Attorney firm, Primary examiner, Assistant examiner, CPCs, and Abstract. The patent badge does contain a link to the full patent document (in Adobe Acrobat format, aka pdf). To download or print any patent click here.
Patent No.:
Date of Patent:
Oct. 25, 2022
Filed:
May. 16, 2019
Collectivehealth, Inc., San Francisco, CA (US);
Nicholas Halpern-Manners, San Francisco, CA (US);
Thomas Bedingten, San Francisco, CA (US);
Andrew Chang, San Francisco, CA (US);
Yulia Eskin, San Francisco, CA (US);
Erica Leigh Horowitz, San Francisco, CA (US);
Chetan Subramanya Ithal, Sunnyvale, CA (US);
Asif Khalak, Belmont, CA (US);
Sergio Martinez-Ortuno, Oakland, CA (US);
Raphael N'Gouan, Belmont, CA (US);
John George O'Leary, San Francisco, CA (US);
Izac Benjamin Milstein Ross, San Francisco, CA (US);
Xiaowen Ye, Castro Valley, CA (US);
Heather Grates, Oakland, CA (US);
Irene Victoria Tollinger, Los Altos, CA (US);
Henning Chiv, Castro Valley, CA (US);
CollectiveHealth, Inc., San Francisco, CA (US);
Abstract
A claim adjudication system including an automatic adjudication pipeline that uses pipeline rules to automatically adjudicate a claim associated with a benefit plan at one or more stages. The automatic adjudication pipeline can redirect the claim to a user interface for manual review when a pipeline rule associated with a manual review condition is triggered. The user interface can present information about the claim relevant to the manual review condition in an integrated format, including highlighting the reasons for the manual review. A user can evaluate the claim in the user interface and provide user input that addresses the manual review condition, and the claim can be routed back to the automatic adjudication pipeline. The user input can also be used as training data for machine learning to adjust pipeline rules that are used to automatically process claims and to redirect future claims for manual review.