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

Claim 0:
1. A method comprising:
receiving, by a computing system, via a communications network, a verification of benefits (VoB) request that was submitted by a healthcare provider and that identifies a subscriber, 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:
determining, by the computing system, whether the health insurance policy of the subscriber is active; and
providing, by the computing system, a VoB response to the healthcare provider, the VoB response indicating whether the health insurance policy of the subscriber is active;

identifying, by the computing system, 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 comprise 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:
determining, by the computing system, 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 determining whether to send the subscriber alert comprises:
selecting, by the computing system, a predictive model that corresponds to the healthcare provider;
applying, by the computing system, the predictive model to determine a first set of follow-on healthcare providers;
determining, by the computing system, whether the VoB request was submitted by one of the first set of follow-on healthcare providers; and
determining, by the computing system, 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:
sending, by the computing system, the subscriber alert to the subscriber via the communication channel, or
instructing, by the computing system, another computing system to send the subscriber alert to the subscriber via the communication channel.