Abstract: A pathway identification system includes processor and memory hardware. The memory hardware stores a pathway database including pathways corresponding to at least one pathway parameter, a framework database including a set of framework transformation models, and instructions. The instructions include, in response to receiving a first pathway parameter corresponding to a user, identifying a subset of pathways of the pathways corresponding to the first pathway parameter. The instructions include obtaining a first set of framework transformation models from the framework database, determining a pathway value for each pathway of the subset of pathways using the first set of framework transformation models, and selecting at least one pathway of the subset of pathways based on the corresponding pathway value. The instructions include transmitting information encoding the at least one pathway to the operator device and transforming a user interface of the operator device to display the at least one pathway.

Abstract: A computerized method of automated linking management of regimen database entries includes receiving one or more clinical responses via a user interface, searching a production database to identify a regimen group database entry, and obtaining each drug regimen database entry linked with the identified regimen group database entry. The method includes receiving a selection of one of the drug regimen database entries via the user interface, and obtaining structured drug attribute data for each drug database entry linked with the selected drug regimen database entry. The structured drug attribute data for each drug regimen database entry includes structured dosage data. In response to receiving a regimen authorization request via the user interface, the method includes generating a drug authorization request for each drug database entry linked with the selected drug regimen database entry, and transmitting the generated drug authorization requests to a claim processing engine.

Abstract: A pathway identification system includes processor and memory hardware. The memory hardware stores a pathway database including pathways corresponding to at least one pathway parameter, a framework database including a set of framework transformation models, and instructions. The instructions include, in response to receiving a first pathway parameter corresponding to a user, identifying a subset of pathways of the pathways corresponding to the first pathway parameter. The instructions include obtaining a first set of framework transformation models from the framework database, determining a pathway value for each pathway of the subset of pathways using the first set of framework transformation models, and selecting at least one pathway of the subset of pathways based on the corresponding pathway value. The instructions include transmitting information encoding the at least one pathway to the operator device and transforming a user interface of the operator device to display the at least one pathway.

Abstract: A pathway identification system includes processor and memory hardware. The memory hardware stores a pathway database including pathways corresponding to at least one pathway parameter, a framework database including a set of framework transformation models, and instructions. The instructions include, in response to receiving a first pathway parameter corresponding to a user, identifying a subset of pathways of the pathways corresponding to the first pathway parameter. The instructions include obtaining a first set of framework transformation models from the framework database, determining a pathway value for each pathway of the subset of pathways using the first set of framework transformation models, and selecting at least one pathway of the subset of pathways based on the corresponding pathway value. The instructions include transmitting information encoding the at least one pathway to the operator device and transforming a user interface of the operator device to display the at least one pathway.

Abstract: A pathway identification system includes processor and memory hardware. The memory hardware stores a pathway database including pathways corresponding to at least one pathway parameter, a framework database including a set of framework transformation models, and instructions. The instructions include, in response to receiving a first pathway parameter corresponding to a user, identifying a subset of pathways of the pathways corresponding to the first pathway parameter. The instructions include obtaining a first set of framework transformation models from the framework database, determining a pathway value for each pathway of the subset of pathways using the first set of framework transformation models, and selecting at least one pathway of the subset of pathways based on the corresponding pathway value. The instructions include transmitting information encoding the at least one pathway to the operator device and transforming a user interface of the operator device to display the at least one pathway.

Abstract: A trained predictive server is provided for determining that a diagnosis and treatment plan is inaccurate. The trained predictive server includes a processor configured to receive a set of prior authorization (PA) data associated with a medical claim for a patient, and determine that the set of PA data indicates that the medical claim is associated with a qualifying critical illness. The processor is further configured to extract component data from the set of PA data, and apply the extracted component data to a trained predictive model associated with the qualifying critical illness to determine whether the medical claim is associated with an inaccurate diagnosis and treatment plan. Upon determining that the medical claim is associated with an inaccurate diagnosis and treatment plan, the processor is configured to generate a request for a consulting review of the diagnosis and treatment plan using the set of PA data.