Patent ID: 11861717
Assignee: OPTUM, INC.
Field: Computer technology (Electrical engineering)
Classification: CPC G | IPC G

Claim 12:
13. A non-transitory computer-readable storage medium having instructions stored thereon that, when executed, configure a computing system to:
receive, via a communications network, a verification of benefits (VoB) request that identifies a subscriber and a healthcare provider that submitted the VoB request, the VoB request comprising a request for the computing system to verify that a health insurance policy of the subscriber is active;
in response to receiving the VoB request:
determine whether the health insurance policy of the subscriber is active; and
provide a VoB response to the healthcare provider, the VoB response indicating whether the health insurance policy of the subscriber is active;

identify a communication channel that is specific to the subscriber from among a plurality of communication channels, wherein identifying the communication channel comprises accessing a database that maps a plurality of subscribers to the communication channels, wherein the subscribers comprises the subscriber, and the communication channel is one of a special-purpose application installed on a mobile phone of the subscriber, an email account of the subscriber, an instant message account of the subscriber, a phone number of the subscriber, or a mobile device associated with the subscriber; and
in response to determining that the health insurance policy of the subscriber is active and prior to the healthcare provider performing a healthcare action:
determine whether to send a subscriber alert to the subscriber, wherein the subscriber alert notifies the subscriber that the healthcare provider has been requested to perform the healthcare action for the subscriber in the future as of a time the healthcare provider submitted the VoB request, wherein the instructions configure the computing system to, as part of determining whether to send the subscriber alert:
select a predictive model that corresponds to the healthcare provider;
apply the predictive model to determine a first set of follow-on healthcare providers;
determine whether the VoB request was submitted by one of the first set of follow-on healthcare providers; and
determine to send the subscriber response in response to determining that the VoB request was not submitted by one of the first set of follow-on healthcare providers; and

based on a determination to send the subscriber alert:
send the subscriber alert to the subscriber via the communication channel, or
instruct another computing system to send the subscriber alert to the subscriber via the communication channel.