Patent ID: 11875409
Assignee: DATA-CORE SYSTEMS, INC.
Field: Computer technology (Electrical engineering)
Classification: CPC G | IPC G

Claim 8:
9. The tangible, non-transitory computer readable media of claim 7, wherein the determining that the insurance claim comprises the potential anomaly based at least in part on both (i) whether the insurance claim has the classification determined by the AI/ML engine below the threshold and (ii) whether the insurance claim violates the at least one rule in the Rules Engine comprises:
using the Rules Engine to classify the insurance claim as one of (a) acceptable for payment or (b) unacceptable for payment;
using the AI/ML Engine to classify the insurance claim as one of (a) acceptable for payment or (b) unacceptable for payment;
when the Rules Engine and the AI/ML Engine both classify the insurance claim as acceptable for payment, sending the insurance claim to a payer for payment;
when the Rules Engine and the AI/ML Engine both classify the insurance claim as unacceptable for payment, concluding that the insurance claim comprises the potential anomaly; and
when one of the Rules Engine or the AI/ML Engine classifies the insurance claim as acceptable for payment and the other of the Rules Engine or the AI/ML Engine classifies the insurance claim as unacceptable for payment, assigning the insurance claim the classification generated by the Rules Engine or the classification generated by the AI/ML Engine based on a weighted selection procedure comprising a first set of credits associated with the Rules Engine and a second set of credits associated with the AI/ML Engine.