PREDICTIVE MODELING PROCESSES FOR HEALTHCARE FRAUD DETECTION
A healthcare fraud management system receives healthcare claims, performs data reduction on information associated with the healthcare claims, and processes the reduced information associated with the healthcare claims by using a plurality of rules. The system also generates alarms, for the healthca...
Gespeichert in:
| Hauptverfasser: | , , , , , , |
|---|---|
| Format: | Patent |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext bestellen |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | |
|---|---|
| container_issue | |
| container_start_page | |
| container_title | |
| container_volume | |
| creator | SCHWEYEN CORRINE L HAGINS SCOTT MAHONE SARALYN M VAN ARKEL JOHN H CURTIS TERRILL J TADA DAVID D WAGNER JAMES J |
| description | A healthcare fraud management system receives healthcare claims, performs data reduction on information associated with the healthcare claims, and processes the reduced information associated with the healthcare claims by using a plurality of rules. The system also generates alarms, for the healthcare claims, based on the processing of the reduced information associated with the healthcare claims, generates scores for the alarms based on one or more predictive modeling rules, and prioritizes the healthcare claims, to create a list of prioritized healthcare claims, based on the generated scores for the alarms corresponding to the healthcare claims. The system further outputs, prior to payment of the healthcare claims, the list of the prioritized healthcare claims to a clearinghouse or a claims processor to assist the clearinghouse or the claims processor in determining whether to accept, deny, or review the healthcare claims. |
| format | Patent |
| fullrecord | <record><control><sourceid>epo_EVB</sourceid><recordid>TN_cdi_epo_espacenet_US2013006668A1</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>US2013006668A1</sourcerecordid><originalsourceid>FETCH-epo_espacenet_US2013006668A13</originalsourceid><addsrcrecordid>eNrjZLAJCHJ18XQO8QxzVfD1d3H18fRzVwgI8nd2DQ52DVZw8w9S8HB19AnxcHYMclVwC3IMdVFwcQ1xBerw9-NhYE1LzClO5YXS3AzKbq4hzh66qQX58anFBYnJqXmpJfGhwUYGhsYGBmZmZhaOhsbEqQIAuSYqlQ</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>patent</recordtype></control><display><type>patent</type><title>PREDICTIVE MODELING PROCESSES FOR HEALTHCARE FRAUD DETECTION</title><source>esp@cenet</source><creator>SCHWEYEN CORRINE L ; HAGINS SCOTT ; MAHONE SARALYN M ; VAN ARKEL JOHN H ; CURTIS TERRILL J ; TADA DAVID D ; WAGNER JAMES J</creator><creatorcontrib>SCHWEYEN CORRINE L ; HAGINS SCOTT ; MAHONE SARALYN M ; VAN ARKEL JOHN H ; CURTIS TERRILL J ; TADA DAVID D ; WAGNER JAMES J</creatorcontrib><description>A healthcare fraud management system receives healthcare claims, performs data reduction on information associated with the healthcare claims, and processes the reduced information associated with the healthcare claims by using a plurality of rules. The system also generates alarms, for the healthcare claims, based on the processing of the reduced information associated with the healthcare claims, generates scores for the alarms based on one or more predictive modeling rules, and prioritizes the healthcare claims, to create a list of prioritized healthcare claims, based on the generated scores for the alarms corresponding to the healthcare claims. The system further outputs, prior to payment of the healthcare claims, the list of the prioritized healthcare claims to a clearinghouse or a claims processor to assist the clearinghouse or the claims processor in determining whether to accept, deny, or review the healthcare claims.</description><language>eng</language><subject>HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATIONTECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING ORPROCESSING OF MEDICAL OR HEALTHCARE DATA ; INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTEDFOR SPECIFIC APPLICATION FIELDS ; PHYSICS</subject><creationdate>2013</creationdate><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://worldwide.espacenet.com/publicationDetails/biblio?FT=D&date=20130103&DB=EPODOC&CC=US&NR=2013006668A1$$EHTML$$P50$$Gepo$$Hfree_for_read</linktohtml><link.rule.ids>230,308,776,881,25542,76289</link.rule.ids><linktorsrc>$$Uhttps://worldwide.espacenet.com/publicationDetails/biblio?FT=D&date=20130103&DB=EPODOC&CC=US&NR=2013006668A1$$EView_record_in_European_Patent_Office$$FView_record_in_$$GEuropean_Patent_Office$$Hfree_for_read</linktorsrc></links><search><creatorcontrib>SCHWEYEN CORRINE L</creatorcontrib><creatorcontrib>HAGINS SCOTT</creatorcontrib><creatorcontrib>MAHONE SARALYN M</creatorcontrib><creatorcontrib>VAN ARKEL JOHN H</creatorcontrib><creatorcontrib>CURTIS TERRILL J</creatorcontrib><creatorcontrib>TADA DAVID D</creatorcontrib><creatorcontrib>WAGNER JAMES J</creatorcontrib><title>PREDICTIVE MODELING PROCESSES FOR HEALTHCARE FRAUD DETECTION</title><description>A healthcare fraud management system receives healthcare claims, performs data reduction on information associated with the healthcare claims, and processes the reduced information associated with the healthcare claims by using a plurality of rules. The system also generates alarms, for the healthcare claims, based on the processing of the reduced information associated with the healthcare claims, generates scores for the alarms based on one or more predictive modeling rules, and prioritizes the healthcare claims, to create a list of prioritized healthcare claims, based on the generated scores for the alarms corresponding to the healthcare claims. The system further outputs, prior to payment of the healthcare claims, the list of the prioritized healthcare claims to a clearinghouse or a claims processor to assist the clearinghouse or the claims processor in determining whether to accept, deny, or review the healthcare claims.</description><subject>HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATIONTECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING ORPROCESSING OF MEDICAL OR HEALTHCARE DATA</subject><subject>INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTEDFOR SPECIFIC APPLICATION FIELDS</subject><subject>PHYSICS</subject><fulltext>true</fulltext><rsrctype>patent</rsrctype><creationdate>2013</creationdate><recordtype>patent</recordtype><sourceid>EVB</sourceid><recordid>eNrjZLAJCHJ18XQO8QxzVfD1d3H18fRzVwgI8nd2DQ52DVZw8w9S8HB19AnxcHYMclVwC3IMdVFwcQ1xBerw9-NhYE1LzClO5YXS3AzKbq4hzh66qQX58anFBYnJqXmpJfGhwUYGhsYGBmZmZhaOhsbEqQIAuSYqlQ</recordid><startdate>20130103</startdate><enddate>20130103</enddate><creator>SCHWEYEN CORRINE L</creator><creator>HAGINS SCOTT</creator><creator>MAHONE SARALYN M</creator><creator>VAN ARKEL JOHN H</creator><creator>CURTIS TERRILL J</creator><creator>TADA DAVID D</creator><creator>WAGNER JAMES J</creator><scope>EVB</scope></search><sort><creationdate>20130103</creationdate><title>PREDICTIVE MODELING PROCESSES FOR HEALTHCARE FRAUD DETECTION</title><author>SCHWEYEN CORRINE L ; HAGINS SCOTT ; MAHONE SARALYN M ; VAN ARKEL JOHN H ; CURTIS TERRILL J ; TADA DAVID D ; WAGNER JAMES J</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-epo_espacenet_US2013006668A13</frbrgroupid><rsrctype>patents</rsrctype><prefilter>patents</prefilter><language>eng</language><creationdate>2013</creationdate><topic>HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATIONTECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING ORPROCESSING OF MEDICAL OR HEALTHCARE DATA</topic><topic>INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTEDFOR SPECIFIC APPLICATION FIELDS</topic><topic>PHYSICS</topic><toplevel>online_resources</toplevel><creatorcontrib>SCHWEYEN CORRINE L</creatorcontrib><creatorcontrib>HAGINS SCOTT</creatorcontrib><creatorcontrib>MAHONE SARALYN M</creatorcontrib><creatorcontrib>VAN ARKEL JOHN H</creatorcontrib><creatorcontrib>CURTIS TERRILL J</creatorcontrib><creatorcontrib>TADA DAVID D</creatorcontrib><creatorcontrib>WAGNER JAMES J</creatorcontrib><collection>esp@cenet</collection></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext_linktorsrc</fulltext></delivery><addata><au>SCHWEYEN CORRINE L</au><au>HAGINS SCOTT</au><au>MAHONE SARALYN M</au><au>VAN ARKEL JOHN H</au><au>CURTIS TERRILL J</au><au>TADA DAVID D</au><au>WAGNER JAMES J</au><format>patent</format><genre>patent</genre><ristype>GEN</ristype><title>PREDICTIVE MODELING PROCESSES FOR HEALTHCARE FRAUD DETECTION</title><date>2013-01-03</date><risdate>2013</risdate><abstract>A healthcare fraud management system receives healthcare claims, performs data reduction on information associated with the healthcare claims, and processes the reduced information associated with the healthcare claims by using a plurality of rules. The system also generates alarms, for the healthcare claims, based on the processing of the reduced information associated with the healthcare claims, generates scores for the alarms based on one or more predictive modeling rules, and prioritizes the healthcare claims, to create a list of prioritized healthcare claims, based on the generated scores for the alarms corresponding to the healthcare claims. The system further outputs, prior to payment of the healthcare claims, the list of the prioritized healthcare claims to a clearinghouse or a claims processor to assist the clearinghouse or the claims processor in determining whether to accept, deny, or review the healthcare claims.</abstract><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext_linktorsrc |
| identifier | |
| ispartof | |
| issn | |
| language | eng |
| recordid | cdi_epo_espacenet_US2013006668A1 |
| source | esp@cenet |
| subjects | HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATIONTECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING ORPROCESSING OF MEDICAL OR HEALTHCARE DATA INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTEDFOR SPECIFIC APPLICATION FIELDS PHYSICS |
| title | PREDICTIVE MODELING PROCESSES FOR HEALTHCARE FRAUD DETECTION |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-09T16%3A37%3A37IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-epo_EVB&rft_val_fmt=info:ofi/fmt:kev:mtx:patent&rft.genre=patent&rft.au=SCHWEYEN%20CORRINE%20L&rft.date=2013-01-03&rft_id=info:doi/&rft_dat=%3Cepo_EVB%3EUS2013006668A1%3C/epo_EVB%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_id=info:pmid/&rfr_iscdi=true |