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Dynamic topological system and method for efficient claims processing

  • US 10,474,792 B2
  • Filed: 11/12/2015
  • Issued: 11/12/2019
  • Est. Priority Date: 05/18/2015
  • Status: Active Grant
First Claim
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1. A healthcare claims processing apparatus, comprising:

  • a computer system having a processor and a memory;

    a database associated with the computer system that stores one or more claims records wherein each claim record contains data about a claim and the database stores data about a plurality of claims;

    a claims processing component that generates a compressed representation of the plurality of claims including a particular claim in the one or more claims records, the compressed representation having a plurality of nodes with which the particular claim is associated, partitions the compressed representation into one or more neighborhoods of nodes using a weighted undirected graph having a plurality of vertexes and a plurality of edges that connect two of the plurality of vertexes and each vertex represents a neighborhood of nodes and has a weight and each edge joins two vertexes only if at least one of the claims in the two vertexes exists in each vertex, identifies the neighborhood of nodes that includes the particular claim and determines, using a classifier for the identified neighborhood of nodes for the particular claim, a status of the particular claim, wherein the status is one of denied, overpaid or underpaid.

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