Medical claims lead summary report generation
First Claim
1. A computer-implemented method comprising:
- in response to receiving lead data identifying an entity associated with a health care claim relating to suspected fraud, determining one or more data sources that were used to identify the entity or the suspected fraud by determining two or more sources from among a plurality of sources;
applying two or more weight values, respectively, to each of the two or more sources;
based on two or more of the weight values, determining whether each of the two or more sources is at or above a threshold;
accessing a pre-defined subset corresponding to each of the two or more of the sources that satisfies the threshold;
determining a plurality of data display elements based on the pre-defined subset, wherein each of the plurality of data display elements is configured to cause displaying health care claims data associated with the entity in a designated format;
applying a weight to each of the plurality of data display elements based upon historical levels of user interaction with each of the plurality of data display elements displayed within historical lead summary reports;
determining whether each of the weighted plurality of data display elements is at or above at least one threshold;
combining the obtained pre-defined subsets to form a subset of the plurality of data display elements, wherein each data display element in the subset satisfies the at least one threshold;
automatically obtaining, from a data repository, specific health care claims data associated with the entity for each of the plurality of data display elements in the subset;
generating a lead summary report associated with the entity using a report template, the subset, and the obtained specific health care claims data;
wherein the method is performed by one or more computing devices.
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Accused Products
Abstract
In an embodiment, a computer-implemented method comprises, in response to receiving lead data identifying an entity associated with a health care claim relating to suspected fraud, determining one or more data sources that were used to identify the entity or the suspected fraud; determining a subset of a plurality of data display elements, based on the determined one or more data sources, wherein each of the plurality of data display elements is configured to cause displaying health care claims data associated with the entity in a designated format; automatically obtaining, from a data repository, specific health care claims data associated with the entity for each of the plurality of data display elements in the subset; generating a lead summary report associated with the entity using a report template, the subset, and the obtained specific health care claims data.
613 Citations
26 Claims
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1. A computer-implemented method comprising:
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in response to receiving lead data identifying an entity associated with a health care claim relating to suspected fraud, determining one or more data sources that were used to identify the entity or the suspected fraud by determining two or more sources from among a plurality of sources; applying two or more weight values, respectively, to each of the two or more sources; based on two or more of the weight values, determining whether each of the two or more sources is at or above a threshold; accessing a pre-defined subset corresponding to each of the two or more of the sources that satisfies the threshold; determining a plurality of data display elements based on the pre-defined subset, wherein each of the plurality of data display elements is configured to cause displaying health care claims data associated with the entity in a designated format; applying a weight to each of the plurality of data display elements based upon historical levels of user interaction with each of the plurality of data display elements displayed within historical lead summary reports; determining whether each of the weighted plurality of data display elements is at or above at least one threshold; combining the obtained pre-defined subsets to form a subset of the plurality of data display elements, wherein each data display element in the subset satisfies the at least one threshold; automatically obtaining, from a data repository, specific health care claims data associated with the entity for each of the plurality of data display elements in the subset; generating a lead summary report associated with the entity using a report template, the subset, and the obtained specific health care claims data; wherein the method is performed by one or more computing devices. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 23, 24, 25)
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10. A computer system comprising:
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one or more databases including a plurality of health care claims data and a plurality of data display elements; a report generator component, at least partially implemented by computing hardware, coupled to the one or more databases and comprising one or more sequences of instructions which when executed by one or more processors are programmed to perform; in response to receiving lead data identifying an entity associated with a health care claim relating to suspected fraud, determining one or more data sources that were used to identify the entity or the suspected fraud by determining two or more sources from among a plurality of sources; applying two or more weight values, respectively, to each of the two or more sources; based on two or more of the weight values, determining whether each of the two or more sources is at or above a threshold; accessing a pre-defined subset corresponding to each of the two or more of the sources that satisfies the threshold; determining a plurality of data display elements based on the pre-defined subset, wherein each of the plurality of data display elements is configured to cause displaying health care claims data associated with the entity in a designated format; applying a weight to each of the plurality of data display elements based upon historical levels of user interaction with each of the plurality of data display elements displayed within historical lead summary reports; determining whether each of the weighted plurality of data display elements is at or above at least one threshold; combining the obtained pre-defined subsets to form a subset of a plurality of data display elements, wherein each data display element in the subset satisfies the at least one threshold; automatically obtaining, from a data repository, specific health care claims data associated with the entity for each of the plurality of data display elements in the subset; generating a lead summary report associated with the entity using a report template, the subset, and the obtained specific health care claims data. - View Dependent Claims (11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 26)
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Specification