Advanced insurance record audit and payment integrity

US7860812B2 · kind B2 · utility

Assignee

• ACCENTURE GLOBAL SERVICES LIMITED · IE

Inventors

• Michael Scott Hartley · Atlanta, US
• Leana Rachelle Wallace · San Francisco, US
• Lisa Marie Henning · Denver, US
• Nicholas Francisco Howell · San Marino, US
• Sanjay Mathur · Laguna Hills, US

Key dates

• Filing date: Mar 2, 2005
• Grant date: Dec 28, 2010
• Expiry date: Mar 4, 2029

Classification

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

Abstract

Methods and systems for identifying and resolving payment integrity issues are provided. Analytic techniques that may include a query component, an artificial intelligence engine, and a text mining component are integrated into a payment integrity system. One or more of the analysis components provide information from a source transaction system to an audit module. The audit module utilizes the outputs from the analysis components to resolve whether or not a claim payment was overpaid or underpaid. The audit module may subsequently instruct one of the analysis components to further analyze information from the source transaction system in accordance with previously provided information from another analysis component.