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.

Date of Patent:
Jan. 21, 2025

Filed:

Feb. 14, 2022
Applicant:

Evernorth Strategic Development, Inc., St. Louis, MO (US);

Inventor:

Ankur Kaneria, Cedar Park, TX (US);

Assignee:
Attorney:
Primary Examiner:
Int. Cl.
CPC ...
G06Q 40/08 (2012.01); G06N 20/00 (2019.01); G06Q 10/10 (2023.01);
U.S. Cl.
CPC ...
G06Q 40/08 (2013.01); G06N 20/00 (2019.01); G06Q 10/10 (2013.01);
Abstract

Systems and methods herein describe probability-based health claims processing. The described systems and methods access a plurality of pharmacy claims, determine an aggregate rating of the pharmacy claims based on pharmacy claims data, submit a first subset of pharmacy claims to a first pharmacy claims approval system, submit a second subset of pharmacy claims of the plurality of pharmacy claims to a second pharmacy claims approval system, receive, from the first pharmacy claims approval system, a first set of decisions for the first subset of pharmacy claims, and, receive from the second pharmacy claims approval system, a second set of decisions for the second subset of pharmacy claims.


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