Abstract: In an illustrative embodiment, a system for providing automation and virtual assistance to medical claims processing includes a predictive analytics platform configured to receive patient information for a medical claim from a claims processing system, cross-reference the patient information with stored data to identify a patient record, apply the patient information to machine learning classifier(s) to estimate a likelihood of match between the patient information and the patient record, provide patient record information to the claims system, receive claims data from the claims system, access, from a data universe, requirements corresponding to a payer corresponding to the medical claim, the requirements having been generated through training machine learning classifier(s) with claims data corresponding to claims denied by the payer, verify the claims data in view of the requirements, and provide an indication of missing claims information and/or invalid claims information to the claims system.

Abstract: Systems and methods for calculating medical claims payment estimates may receive a medical claim for a first patient including billing code(s) and demographic data, apply the demographic data to identify payer(s) for the first patient, access a data universe including patient data collection(s) of patient data records for a second group of patients, payer data collection(s) of data records for payers, and a financial history data collection including financial data record(s) for the first patient, identify, for each billing code, a payer payment pattern based on a combination of the patient data records and payer data record(s) corresponding to the payer for the first patient, identify a patient payment pattern based on the financial data record(s), and apply the payer payment pattern and the patient payment pattern to the medical claim for the first patient to calculate a payment estimation for the medical claim.

Abstract: In an illustrative embodiment, a system for providing automation and virtual assistance to medical claims processing includes a predictive analytics platform configured to receive patient information for a medical claim from a claims processing system, cross-reference the patient information with stored data to identify a patient record, apply the patient information to machine learning classifier(s) to estimate a likelihood of match between the patient information and the patient record, provide patient record information to the claims system, receive claims data from the claims system, access, from a data universe, requirements corresponding to a payer corresponding to the medical claim, the requirements having been generated through training machine learning classifier(s) with claims data corresponding to claims denied by the payer, verify the claims data in view of the requirements, and provide an indication of missing claims information and/or invalid claims information to the claims system.

Abstract: In an illustrative embodiment, a system for providing automation and virtual assistance to medical claims processing includes a predictive analytics platform configured to receive patient information for a medical claim from a claims processing system, cross-reference the patient information with stored data to identify a patient record, apply the patient information to machine learning classifier(s) to estimate a likelihood of match between the patient information and the patient record, provide patient record information to the claims system, receive claims data from the claims system, access, from a data universe, requirements corresponding to a payer corresponding to the medical claim, the requirements having been generated through training machine learning classifier(s) with claims data corresponding to claims denied by the payer, verify the claims data in view of the requirements, and provide an indication of missing claims information and/or invalid claims information to the claims system.

Abstract: Systems and methods for calculating medical claims payment estimates may receive a medical claim for a first patient including billing code(s) and demographic data, apply the demographic data to identify payer(s) for the first patient, access a data universe including patient data collection(s) of patient data records for a second group of patients, payer data collection(s) of data records for payers, and a financial history data collection including financial data record(s) for the first patient, identify, for each billing code, a payer payment pattern based on a combination of the patient data records and payer data record(s) corresponding to the payer for the first patient, identify a patient payment pattern based on the financial data record(s), and apply the payer payment pattern and the patient payment pattern to the medical claim for the first patient to calculate a payment estimation for the medical claim.