Abstract: A method and computing apparatus for automatically identifying whether or not one or more identified injuries are related to the insurance claim which has been submitted is described. The method and computing apparatus identify injury data in an electronic medical claim data associated with a claimant based diagnosis code data, uses a classifier to determine an association between the identified injury data represented by the diagnosis code data and the initial injury data represented by the initial diagnosis code data is identified when historical claim data is determined to be present for the claimant.

Abstract: A method, non-transitory computer readable medium, and apparatus that identifies one of a plurality of diagnostic mapping tables based on a diagnostic code associated with one of a plurality of data environment formats in an electronic claim. The diagnostic code associated with one of the plurality of data environment formats is correlated to at least one of a plurality of parts and laterality associated with another one of the plurality of data environment formats based on the identified one of the plurality of diagnostic code mapping tables. One of a plurality of assessment ratings is determined based on the diagnostic code the correlated one of the plurality of parts and the laterality, and a categorization table associated with the another one of the plurality of data environment formats. Execution of one of a plurality of actions on the electronic claim in response to the determined one of the plurality of assessment ratings for the diagnostic code is initiated.

Abstract: A method and computing apparatus for automatically identifying whether or not one or more identified injuries are related to the insurance claim which has been submitted is described. The method and computing apparatus identify injury data in an electronic medical claim data associated with a claimant based diagnosis code data, uses a classifier to determine an association between the identified injury data represented by the diagnosis code data and the initial injury data represented by the initial diagnosis code data is identified when historical claim data is determined to be present for the claimant.

Abstract: System and methods for automated claim processing with endnote hierarchy are provided. In some embodiments, a computer-implemented method comprises: receiving an insurance claim, wherein the insurance claim comprises at least one line, and wherein each line comprises at least one procedure code and at least one explanation code; determining a first hierarchical rank of a plurality of the hierarchical ranks for a first explanation code in a first line based on predetermined associations between the explanation codes and the hierarchical ranks; determining, according to the determined first hierarchical rank for the first explanation code, whether the first line comprising the first code should be modified; modifying the first line comprising the first explanation code when it is determined that the first line comprising the first explanation code should be modified; and outputting the insurance claim after determining whether the first line comprising the first explanation code should be modified.

Abstract: Disclosed technology includes identifying injury data in an electronic medical claim data associated with a claimant based diagnosis code data present in the electronic medical claim data. Presence of historical claim data including initial injury data represented by initial diagnosis code data associated with the claimant for the electronic medical claim data is determined. At least one type of clinical correlation of a plurality of clinical correlations between the identified injury data represented by the diagnosis code data and the initial injury data represented by the initial diagnosis code data is identified when historical claim data is determined to be present for the claimant. Claim processing guidance data to process the electronic medical claim data is provided based on the identified at least one type of correlation between the identified injury data represented by the diagnosis code data and the initial injury data represented by the initial diagnosis code data.

Abstract: A method, non-transitory computer readable medium, and apparatus that identifies one of a plurality of diagnostic mapping tables based on a diagnostic code associated with one of a plurality of data environment formats in an electronic claim. The diagnostic code associated with one of the plurality of data environment formats is correlated to at least one of a plurality of parts and laterality associated with another one of the plurality of data environment formats based on the identified one of the plurality of diagnostic code mapping tables. One of a plurality of assessment ratings is determined based on the diagnostic code the correlated one of the plurality of parts and the laterality, and a categorization table associated with the another one of the plurality of data environment formats. Execution of one of a plurality of actions on the electronic claim in response to the determined one of the plurality of assessment ratings for the diagnostic code is initiated.