Patent ID: 11961598
Assignee: EXPRESS SCRIPTS STRATEGIC DEVELOPMENT, INC.
Field: Medical technology (Instruments)
Classification: CPC G | IPC G

Claim 14:
15. A system comprising a first non-transitory computer readable storage medium of a claim analysis device and a second non-transitory computer readable storage medium of a pharmacy fulfillment device,
the first non-transitory computer readable storage medium having stored thereon a first set of instructions for processing instructions of a software program that when executed by the claim analysis device, causes the claim analysis device to:
extract subsets of historical claim features from a subset of historical claims received from a data warehouse system, wherein each of the subset of historical claims has a corresponding historical claim status indicating that the claim has been successfully processed;
extract a subset of pending claim features from a pending claim received from a claim processing system;
apply a binarization process on the extracted subsets of historical claim features to obtain a binarized training feature set for the subset of historical claims;
apply the binarization process on the extracted subset of pending claim features to obtain a binarized pending feature set for the pending claim;
calculate an aggregate distance between the binarized pending feature set and the binarized training feature set for the subset of historical claims;
identify, from the subset of historical claims, a historical claim associated with the least aggregate distance as a predictive historical claim;
determine that a billing attribute of the predictive historical claim matches a corresponding billing attribute of the pending claim;
validate the pending claim and transmit an instruction to the pharmacy fulfillment device for dispensing the prescription drug in accordance with the pending claim; and
the second non-transitory computer readable storage medium of the pharmacy fulfillment device having stored thereon a second set of instructions that, when executed by the pharmacy fulfillment device, cause the pharmacy fulfillment device to:
dispense the prescription drug based on the instruction from the claim analysis device.