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

Claim 7:
8. 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 whether the insurance claim violates the at least one rule in the Rules Engine comprises:
determining whether the insurance claim comprises at least one of (i) a combination of one or more procedure codes that violates a rule in the Rules Engine, (ii) a combination of one or more diagnosis codes that violates a rule in the Rules Engine, (iii) a combination of one or more diagnosis codes with one or more procedure codes that violates a rule in the Rules Engine, (iv) a combination of patient gender and one or more diagnosis codes or procedure codes that violates a rule in the Rules Engine, or (v) a combination of patient age and one or more diagnosis codes or procedure codes that violates a rule in the Rules Engine.