PATENT CLAIM ANALYSIS

Application Number: 16428291
Application Type: Utility
Filing Date: 2019-05
Publication Date: 2019-09
Patent Classification: ["705", "002000"]

Abstract:
Systems and methods for overriding claim denials and approvals are provided that determine that a current claim will be denied and search the purchasing member's claim history for previously approved claims that match the current claim. If a matching claim is found and is dated within a certain predetermined window of time, the current claim is approved. Additionally, when it is determined that a current claim will be approved at a high tier level the member's claim history is searched for a previously approved claim that matches the current claim and a formulary crosswalk analysis is performed. If a matching claim with a lower tier level is found in the member's claim history or the crosswalk analysis determines that a lower tier level is available, the current claim is processed using the lower tier. Claims overridden are digitally stamped for reporting purposes and for subsequent claim matching.

Claim (Index 15):
The system of  claim 14 , wherein the one or more programmed modules are further configured to store, in association with the record of the current claim, an indication that the prospective denial of the recorded claim was overridden or that the recorded claim was adjudicated based on the prior tier.

Metadata:
- Claim Count in Document: 4.0
- Percentile: 100.0
- Lexical Diversity: 2.28986
- Patent Class: 705.0
- Transitional Phrase Type: none
- Component Type: 0
- Foreign Priority: False
- Related Applications: ['12913685', '10357917', '10608265', '11693170', '13780073']

Analysis Scores:
- 35 USC 101 Eligibility (BERT): 0.1334404357628604
- 35 USC 102 Novelty (BERT): 0.5327157502332134
- Combined Prediction Score: 0.1733679672098957
- Mean Citation Score: 233.802292
- Max Citation Score: 352.023
- Similarity Product: 199.73507302880287

Labels:
- Claim Label 101: 1
- Claim Label 102: 1
- Claim Label 103: 1
- Claim Label 112: 1
- Combined Label: 1
- Label 101 Adjusted: 1

Dataset: test