PATENT CLAIM ANALYSIS

Application Number: 16234405
Application Type: Utility
Filing Date: 2018-12
Publication Date: 2019-10
Patent Classification: ["705", "003000"]

Abstract:
Computer implemented methods and systems for bundled payment adjudication are disclosed. The method includes receiving patient information of patient. The patient information comprises at least patient identifier and clinical episode of patient. The method includes generating episode card for patient to avail healthcare services from one or more healthcare service providers for predefined time. The episode card includes claims submission information for healthcare services availed by patient from one or more healthcare service providers. The method includes receiving one or more claims associated with patient from at least one healthcare service provider. Each claim is associated with one or more healthcare services availed by patient for clinical episode using episode card. The method includes processing one or more claims for determining validity of each claim based on set of episode definition parameters. The method includes upon processing the claims, facilitating payment amount for one or more claims based on validity.

Claim (Index 17):
A method, comprising:\n receiving, by a processor, patient information of a patient, the patient information comprising at least a patient identifier, a clinical episode associated with the patient, and a primary health insurance information associated with the patient; accessing, by the processor, eligibility information of the patient based on an eligibility file provided by an insurance service provider or an employer group, the eligibility file comprising health insurance details of the patient; determining, by the processor, an eligibility of the patient for a bundled payment of claims for the clinical episode based on the eligibility information; upon determining the patient as an eligible candidate for the bundled payment of claims, generating, by the processor, an episode card for the patient to avail healthcare services from one or more healthcare service providers for a predefined time, wherein the one or more healthcare service providers raise one or more claims for at least one health care service availed by the patient using the episode card; processing, by the processor, the one or more claims for determining validity of each claim of the one or more claims based on a comparison of the one or more health care services associated with each claim with a set of episode definition parameters, wherein the set of episode definition parameters is predefined for the clinical episode and comprises information of at least valid diagnoses of the clinical episode; and upon processing the one or more claims, facilitating, by the processor, a payment amount for the one or more claims of the at least one health care service provider based on the validity.

Metadata:
- Claim Count in Document: 50.0
- Percentile: 98.0
- Lexical Diversity: 2.5
- Patent Class: 705.0
- Transitional Phrase Type: open
- Component Type: 1
- Foreign Priority: False
- Related Applications: ['11755713', '10253223', '13425667', '13713687', '13564047']

Analysis Scores:
- 35 USC 101 Eligibility (BERT): 0.1175992465379973
- 35 USC 102 Novelty (BERT): 0.5366947840508428
- Combined Prediction Score: 0.1595088002892818
- Mean Citation Score: 332.81883000000005
- Max Citation Score: 373.21594
- Similarity Product: 302.2800641740751

Labels:
- Claim Label 101: 1
- Claim Label 102: 1
- Claim Label 103: 0
- Claim Label 112: 1
- Combined Label: 1
- Label 101 Adjusted: 1

Dataset: test