Abstract: Data describing code sets of multiple systems is received. The received data includes a first code set associated with a first system and a second code set associated with a second system. Equivalencies between the first code set and the second code set are determined based on (1) logical definitions associated with the first code set and logical definitions associated with the second code set and (2) one or more outputs associated with the first system and one or more outputs associated with the second system. A coding scheme is identified to standardize the codes in the first code set and the codes in the second code set. Codes of the first code set are mapped to codes of the second code set using the coding scheme.

Abstract: Creating a macro profile of an entity is disclosed. Attribute data associated with an entity is identified from (1) one or more public domain information sources and/or (2) one or more private domain information sources. One or more micro profiles for the entity are generated based on the identified data, each of the micro profiles describing the entity in a single dimension. Transactions associated with the entity and/or interactions between the entity and one or more other entities are monitored. A plurality of the generated micro profiles for the entity is selected. The selected micro profiles are associated to generate a macro profile for the entity, the macro profile describing the entity in multiple dimensions. The monitored transactions and/or monitored interactions are analyzed to identify any discrepancies in the macro profile. The macro profile is updated to account for the identified discrepancies.

Abstract: Systems, methods and computer-readable media for creating and using a health data record. Data relating to a patient's health is received from one or more information sources. The data includes unstructured data and structured data elements. The unstructured data is parsed to identify data elements. At least some of the structured data elements and at least some of the data elements parsed from the unstructured data are normalized to create normalized data elements. A weight is assigned to the normalized data elements. The normalized data elements are mapped in accordance with an ontology. The mapped data is stored in a data repository in accordance with a data model.

Abstract: A collaborative electronic environment for medical workers. First medical worker data, describing a medical condition of a patient and (1) a diagnosis relating to the medical condition associated with a first medical worker; and/or (2) a treatment relating to the medical condition associated with the first medical worker, is maintained in a data repository. Second medical worker data describing one or more of (1) an additional diagnosis relating to the medical condition; (2) an additional treatment relating to the medical condition; (3) commentary regarding the diagnosis; and (4) commentary regarding the treatment, is received from a second medical worker, through the electronic user interface. The second medical worker data is stored in the data repository. At least some of the first medical worker data and at least some of the second medical worker data is displayed in the electronic user interface.

Abstract: Systems, methods and computer-readable media for applying policy enforcement rules to sensitive data. An unstructured data repository for storing unstructured data is maintained. A structured data repository for storing structured data is maintained. Request for information is received. The request is analyzed to determine its context. Based on the context, a policy enforcement action associated with generating a response to the request is identified. The policy enforcement action may be to remove sensitive data in generating the response to the request and/or mask sensitive data in generating a response to the request. An initial response to the request is generated by retrieving unstructured data from the unstructured data repository. Using the structured data maintained in the structured data repository, sensitive data included within the initial response is identified.

Abstract: Data describing a request to identify a treatment option for a patient associated with a diagnosis for the patient is received. In response to the request, data describing a treatment bundle is identified. The treatment bundle includes a plurality of treatments, the treatments include one or more of a procedure, a test, a medication, and a therapy. An insurance claim for the treatment bundle is processed.

Abstract: Decision support information rendering systems and processes. A request for data describing demographic information for a patient is received. The data describing the demographic information for the patient is displayed. Data describing a diagnosis for the patient is received. Based on the data describing the demographic information for the patient and the data describing the diagnosis for the patient, one or more treatment recommendations for the patient is received, the treatment recommendations being generated by an evidence-based decision intelligence system.

Abstract: Decision support information rendering systems and processes. A request for pre-authorization of a medical procedure for a medical condition is received. Data describing the request for pre-authorization is received. A recommendation regarding approval of the request for pre-authorization is received, the recommendation being generated by evidence based decision intelligence system.

Abstract: Systems, methods and computer-readable media for assisting consumers to enroll in a health plan in an online environment. Data comprising residence information, date of birth information and gender information of a consumer is received. Data comprising a type of health insurance product selected by the consumer is received. Data comprising physician information selected by the consumer is received. Result information is retrieved from one or more databases. The result information includes one or more health insurance plans of the type selected by the consumer, and information describing whether physicians associated with the physician information selected by the consumer are included within a network of each of the health insurance plans. The result information is displayed to the consumer. A request from the consumer to enroll in one of the health insurance plans is received.

Abstract: Systems, methods and computer-readable media for transferring control over input of data to electronic forms. An electronic insurance application form including a plurality of form fields for receiving input data is displayed to a consumer. Control over input of data to the form fields is associated with an identifier of the consumer in an access control table for the electronic insurance application form. A request to transfer control over input of data to the form fields to an insurance agent is received from the consumer. The access control table for the electronic insurance application form is updated to associate control over input of data to the form fields with an identifier of the insurance agent. Data describing the electronic insurance application form is transferred to the insurance agent.

Abstract: Systems, methods and computer-readable media for use in connection with healthcare product enrollment. Data describing health profile information from a consumer is received. This data may be based on historical claims information or on responses to survey questions received from the consumer. The data may be for the individual alone, or for his dependents as well. Data describing cost of care information is determined based on the data describing the health profile information. At least one recommended health care coverage product for the consumer is determined based on the cost of care information. In some embodiments, a consumer cost associated with each of the recommended health care coverage product is conveyed to the consumer.

Abstract: Methods and systems for managing health treatment plans are described. Data describing a physical and/or mental status of an individual is received. A visual representation of the status is created. The visual representation is displayed to a representative of the individual. The representative interacts with the visual representation. Feedback data regarding the visual representation is received from the representative. The feedback data is communicated to the individual.

Abstract: The systems and methods relate to decision making processes. Data associated with a request for a decision is received. Risks associated with the request are identified. Decision queries associated with each of the identified risks are determined. Any non-standard attributes associated with each of the identified risks are identified. A confidence level threshold for each of the identified risks is determined. A decision recommendation, generated by a machine learning component, is received. The decision recommendation includes a response to each of the one or more decision queries, determined based on the exceptional attributes, if any, and a confidence level associated with the response. The confidence level is compared to the confidence level threshold. Based on the comparison, a decision path for responding to the request is determined. Decision path actions are determined based on the decision path.

Abstract: In general, variations that occur when health care resources are allocated based on dated information may be corrected by receiving a report of a health care transaction to be processed by a health care intermediary administering a health savings account, determining that the health care transaction creates a variation when the health care transaction was initiated based on an indicated status that is different from the actual status of the health savings account, and resolving the variation by interfacing with the health resource provider to correct the variation.

Abstract: A method for improving call center performance. The method includes the steps of, for each call, collecting data comprising: date, supervisor, associate, and a categorization as to single, last, or transfer; summarizing said data on a periodic basis by supervisor, associate, and percentage of single, last, transfer, and stream, wherein percentage of stream is the residual after subtracting said percentage of single, last, and transfer categories; and presenting said summarized data to supervisors to provide feedback on the effectiveness of said supervisor's call coaching of associates. A system for enhancing call center performance is also provided.

Abstract: A method of presenting information to an administrator. The method includes the steps of accessing a library of actual expenditures on health care by an organization, generating a baseline based on the actual expenditures, enabling an administrator to reconfigure a health benefit plan and generating a display with impact information resulting from the administrator reconfiguring the health benefit plan. A method of optimizing a set of health incentives for an organization is also provided.