Abstract: A method for recommending one or more providers to a member may include receiving a provider request including a member identifier and member specified criteria; retrieving one or more provider identifiers for association with the member specified criteria; retrieving one or more member characteristics for association with the member identifier; for each provider identifier, retrieving one or more provider characteristics for association with the provider identifier; analyzing the member characteristics and the provider characteristics to generate an ordered list of the providers; and transmitting the ordered list of the providers to the member computing device via the provider search interface. The ordered list of the providers may be based upon a relevancy rank of each provider that is specific to the member. The relevancy rank may be a function of at least one of a provider cost factor, a provider quality factor, or a weighted combination thereof.

Abstract: A method for authorizing a treatment may include receiving a treatment authorization request, creating an extracted text of a historical record using optical character recognition on the historical record, determining whether to analyze authorization performance of the treatment using a machine learning authorization process, in response to a determination to analyze authorization performance of the treatment using a machine learning authorization process: identifying authorization criteria for the treatment based on treatment authorization guidelines; identifying a natural language record processing model corresponding to expense authorization guidelines, and performing natural language processing on the extracted text of the record in accordance with the identified natural language record processing model to identify relevant record data in the record, determining whether the relevant record data meets the authorization criteria and in response to a determination that the relevant record data meets the auth

Abstract: In one aspect there is a method for recommending one or more providers to a member. The method may comprise at a server, receiving, from a member computing device via a provider search interface, a provider request including a member identifier and member specified criteria. Retrieving one or more provider identifiers for association with the member specified criteria. Retrieving one or more member characteristics for association with the member identifier. For each provider identifier, retrieving one or more provider characteristics for association with the provider identifier. Analyzing the member characteristics and the provider characteristics to generate an ordered list of the providers, wherein the ordered list of the providers is based upon a relevancy rank of each provider that is specific to the member, wherein the relevancy rank is a function of at least one of: a provider cost factor, a provider quality factor, or a weighted combination thereof.

Abstract: An improved machine learning based method for authorizing the performance of a treatment, comprising the steps of: receiving a treatment authorization request, the treatment authorization request including a historical record of the person who will receive the treatment and treatment identifying information relating to the treatment; creating an extracted text of the historical record using optical character recognition on the historical record; determining whether to analyze authorization performance of the treatment using a machine learning authorization process, wherein the determination is based on treatment identifying information and whether treatment authorization guidelines exist for the identified treatment; in response to a determination to analyze authorization performance of the treatment using a machine learning authorization process: identifying authorization criteria for the treatment based on the treatment authorization guidelines, wherein the authorization criteria includes records data condi

Abstract: In one aspect there is a method for recommending one or more providers to a member. The method may comprise at a server, receiving, from a member computing device via a provider search interface, a provider request including a member identifier and member specified criteria. Retrieving one or more provider identifiers for association with the member specified criteria. Retrieving one or more member characteristics for association with the member identifier. For each provider identifier, retrieving one or more provider characteristics for association with the provider identifier. Analyzing the member characteristics and the provider characteristics to generate an ordered list of the providers, wherein the ordered list of the providers is based upon a relevancy rank of each provider that is specific to the member, wherein the relevancy rank is a function of at least one of: a provider cost factor, a provider quality factor, or a weighted combination thereof.

Abstract: A computer-implemented method for selecting one or more providers having one or more specialties for a network available to members while satisfying one or more constraints, the method comprising: at a first computing device: receiving, from a second computing device separate and distinct from the first computer, a network provider request to select an optimized network of providers, the request including: a desired objective including at least one of provider cost minimization, provider average quality maximization and provider total volume maximization, one or more geographical designations, computing an optimized provider network of one or more selected providers including: applying a model that produces a non-optimized provider network of one or more providers having one or more specialties that satisfies the desired objective for the one or more geographical designations of the members without consideration of the availability in the geographical designation of one or more providers having one or more sp

Abstract: A computer-implemented method for selecting one or more providers having one or more specialties for a network available to members while satisfying one or more constraints, the method comprising: at a first computing device: receiving, from a second computing device separate and distinct from the first computer, a network provider request to select an optimized network of providers, the request including: a desired objective including at least one of provider cost minimization, provider average quality maximization and provider total volume maximization, one or more geographical designations, computing an optimized provider network of one or more selected providers including: applying a model that produces a non-optimized provider network of one or more providers having one or more specialties that satisfies the desired objective for the one or more geographical designations of the members without consideration of the availability in the geographical designation of one or more providers having one or more sp

Abstract: In one aspect there is a method for recommending one or more providers to a member. The method may comprise at a server, receiving, from a member computing device via a provider search interface, a provider request including a member identifier and member specified criteria. Retrieving one or more provider identifiers for association with the member specified criteria. Retrieving one or more member characteristics for association with the member identifier. For each provider identifier, retrieving one or more provider characteristics for association with the provider identifier. Analyzing the member characteristics and the provider characteristics to generate an ordered list of the providers, wherein the ordered list of the providers is based upon a relevancy rank of each provider that is specific to the member, wherein the relevancy rank is a function of at least one of: a provider cost factor, a provider quality factor, or a weighted combination thereof.