Sequencing models of healthcare related states

US7778846B2 · kind B2 · utility

Assignee

• Fair Isaac Corporation · US

Inventors

• Nallan Suresh · Fremont, US
• Jean de Traversay · Beaumont, US
• Hyma Gollamudi · San Diego, US
• Krassimir G. Ianakiev · San Diego, US
• Anu K. Pathria · Village of La Jolla, US
• Michael Tyler · San Diego, US

Key dates

• Filing date: Jul 23, 2007
• Grant date: Aug 17, 2010
• Expiry date: Dec 28, 2028

Classification

• Technology area (CPC G): Physics
• CPC primary: G06Q40/08
• WIPO field: IT methods for management
• WIPO sector: Electrical engineering

Abstract

Transition probability sequencing models and metrics are derived from healthcare claims data to identify potentially fraudulent or abusive practices, providers, doctors, clients, or other entities. Healthcare reimbursement claims from hospitals, skilled nursing facilities, doctors, etc., are processed to identify sequences of states, and transition probability metrics are determined from frequency information pertaining to the states. The metrics can these be further analyzed in predictive or rule based models, or other tools.