Abstract: A method includes receiving a medical claim for payment by a payor; and using an artificial intelligence engine to predict whether the medical claim will be denied by the payor, the artificial intelligence engine comprising a decision tree having at least one level, such that each of the at least one level has a split function associated therewith corresponding to one of a plurality of features associated with the medical claim; wherein a node in the decision tree terminates when at least one of a plurality of termination criteria are satisfied.

Abstract: A method includes receiving input information associated with an examination order for a patient, the input information comprising first information associated with a plurality of variables and second information associated with a free-text query for the examination order; embedding the plurality of variables to generate a plurality of input variable vectors, respectively; embedding the free-text query for the order to generate a free-text query vector; aggregating the plurality of input variable vectors with the free-text query vector to generate an examination order vector; and determining, using an artificial intelligence engine, a medical indication corresponding to the examination order based on the examination order vector.

Abstract: A method includes receiving a current claim associated with care provided to a patient by a provider, the claim including a current diagnosis code and a first current procedural terminology (CPT) code that are based on the care that was provided; identifying, using an artificial intelligence (AI) engine, a second current CPT code based on the current diagnosis code and the first current CPT code; and generating a current confidence level value that the second current CPT code is missing from the current claim.