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 17):
The system of  claim 10 , wherein adjudicating the allowance of the current claim based on the prior tier comprises:\n determining a second tier within the current formulary that is equivalent to the prior tier within the prior formulary; and adjudicating the allowance of the current claim at the second tier within the current formulary.

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): 0.133530119652829
- 35 USC 102 Novelty (BERT): 0.5333356303772995
- Combined Prediction Score: 0.173510670725276
- Mean Citation Score: 233.802292
- Max Citation Score: 352.023
- Similarity Product: 185.55078712910407

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