Abstract: A computer-implemented method comprises: receiving, from an insurer system, an electronic medical bill; generating a decision representing a workflow selected from a plurality of the workflows based on at least one of a plurality of decisioning factors describing the electronic medical bill by providing the electronic medical bill as an inference input to a trained machine learning model, wherein responsive to the inference input the trained machine learning model generates the decision representing a workflow, wherein the trained machine learning model has been trained with historical electronic medical bills and corresponding historical decisions, the workflows including a provider network workflow and a provider negotiations workflow, and routing the electronic medical bill accordingly.

Abstract: Methods, non-transitory machine readable media, and network stack analysis devices that generate optimized preferred provider organization (PPO) network stacks are disclosed. With this technology, electronic transactions are applied to each of a first plurality of network stacks to determine a cost reduction value for each of the first network stacks. Each of the first network stacks includes an ordered subset of networks. The first network stacks are resampled based on the determined cost reduction values. A determination is made when one or more convergence criteria are met by the resampled first network stacks. When the determination indicates that the convergence criteria are not met by the resampled first network stacks, one or more of the first network stacks are modified based on genetic crossover or mutation operation(s) to generate a second plurality of network stacks. The application, resampling, and determination are then repeated for the second network stacks.

Abstract: Embodiments of the application are directed toward a method comprising: receiving, by a transaction management computing apparatus, an electronic payment estimate via a secure communication channel for services rendered by a provider; receiving determining a likelihood of payment acceptance by generating, by the transaction management computing apparatus, an payment amount acceptable to the provider computing device based on data associated with the provider computing device, a type of service provided, or a number of days to make the payment; determining, by the transaction management computing apparatus, whether the generated exact amount is acceptable to the provider computing device; and completing, by the transaction management computing apparatus, a payment transaction with the generated exact amount when the generated exact amount is determined to be acceptable to the provider computing device.

Abstract: Embodiments of the application are directed toward a method comprising: receiving, by a transaction management computing apparatus, an electronic payment estimate via a secure communication channel for services rendered by a provider; receiving determining a likelihood of payment acceptance by generating, by the transaction management computing apparatus, an payment amount acceptable to the provider computing device based on data associated with the provider computing device, a type of service provided, or a number of days to make the payment; determining, by the transaction management computing apparatus, whether the generated exact amount is acceptable to the provider computing device; and completing, by the transaction management computing apparatus, a payment transaction with the generated exact amount when the generated exact amount is determined to be acceptable to the provider computing device.

Abstract: Methods, non-transitory machine readable media, and network stack analysis devices that generate optimized preferred provider organization (PPO) network stacks are disclosed. With this technology, electronic transactions are applied to each of a first plurality of network stacks to determine a cost reduction value for each of the first network stacks. Each of the first network stacks includes an ordered subset of networks. The first network stacks are resampled based on the determined cost reduction values. A determination is made when one or more convergence criteria are met by the resampled first network stacks. When the determination indicates that the convergence criteria are not met by the resampled first network stacks, one or more of the first network stacks are modified based on genetic crossover or mutation operation(s) to generate a second plurality of network stacks. The application, resampling, and determination are then repeated for the second network stacks.