Patents by Inventor Jean de Traversay
Jean de Traversay has filed for patents to protect the following inventions. This listing includes patent applications that are pending as well as patents that have already been granted by the United States Patent and Trademark Office (USPTO).
-
Publication number: 20150039334Abstract: Computer implemented systems and methods of health care claim analysis are provided by storing a claim data set in a computer database, including patient information and a DRG assignment based on at least a primary diagnosis code and one or more associated procedure codes. A nominal DRG weight is determined for the claim data set, using a processor in communication with the computer database. The processor looks up an alternate procedure code in the database, and determines an alternate DRG weight for the claim data set by swapping the associated procedure code with the alternate procedure code. A claim score is output to a user interface in communication with the processor, based at least in part on a difference between the nominal and alternate DRG weights.Type: ApplicationFiled: August 1, 2014Publication date: February 5, 2015Inventors: Jean de Traversay, Yuriy Glagovskiy, Jeremy Hill, Opoku Adu-Gyamfi
-
Publication number: 20150039333Abstract: Computer implemented systems and methods of health care claim data analysis are provided by storing a claim data set in a computer database, including patient information and a DRG assignment based on at least primary and secondary diagnosis codes. A nominal DRG weight is determined for the claim data set, using a processor in communication with the computer database. An alternate DRG weight is determined for the claim data set by swapping the primary and secondary diagnosis codes. A claim rating is generated for the claim data set, based at least in part on a difference between the nominal and alternate DRG weights. The claim rating is output to a user interface in communication with the processor.Type: ApplicationFiled: August 1, 2014Publication date: February 5, 2015Inventors: Jean de Traversay, Yuriy Glagovskiy, Jeremy Hill, Opoku Adu-Gyamfi
-
Patent number: 8666757Abstract: Fraud and abuse detection in an entity's payment coding practices includes the ability to search for fraud at all levels of the hierarchical coded payment system within the context of an unsupervised model. The model uses variables derived and profiles created at any level or at all levels of the hierarchical coded payment system to create a comprehensive description of the payment coding activities submitted by the entity. That description is compared with other peer entities to determine unusual and potentially inappropriate activity. The profiles created may themselves be utilized for purposes other than the detection of fraud and abuse.Type: GrantFiled: November 15, 2002Date of Patent: March 4, 2014Assignee: Fair Isaac CorporationInventors: Nallan C Suresh, Jean de Traversay, Hyma Gollamudi, Anu K Pathria, Michael K Tyler
-
Patent number: 8639522Abstract: Transaction-based behavioral profiling, whereby the entity to be profiled is represented by a stream of transactions, is required in a variety of data mining and predictive modeling applications. An approach is described for assessing inconsistency in the activity of an entity, as a way of detecting fraud and abuse, using service-code information available on each transaction. Inconsistency is based on the concept that certain service-codes naturally co-occur more than do others. An assessment is made of activity consistency looking at the overall activity of an individual entity, as well as looking at the interaction of entities. Several approaches for measuring consistency are provided, including one inspired by latent semantic analysis as used in text analysis. While the description is in the context of fraud detection in healthcare, the techniques are relevant to application in other industries and for purposes other than fraud detection.Type: GrantFiled: April 16, 2008Date of Patent: January 28, 2014Assignee: Fair Isaac CorporationInventors: Anu Kumar Pathria, Andrea L. Allmon, Jean de Traversay, Krassimir G. Ianakiev, Nallan Suresh, Michael K. Tyler
-
Patent number: 7813937Abstract: Transaction-based behavioral profiling, whereby the entity to be profiled is represented by a stream of transactions, is required in a variety of data mining and predictive modeling applications. An approach is described for assessing inconsistency in the activity of an entity, as a way of detecting fraud and abuse, using service-code information available on each transaction. Inconsistency is based on the concept that certain service-codes naturally co-occur more than do others. An assessment is made of activity consistency looking at the overall activity of an individual entity, as well as looking at the interaction of entities. Several approaches for measuring consistency are provided, including one inspired by latent semantic analysis as used in text analysis. While the description is in the context of fraud detection in healthcare, the techniques are relevant to application in other industries and for purposes other than fraud detection.Type: GrantFiled: February 6, 2003Date of Patent: October 12, 2010Assignee: Fair Isaac CorporationInventors: Anu K Pathria, Andrea L Allmon, Jean de Traversay, Krassimir G Ianakiev, Nallan C Suresh, Michael K Tyler
-
Patent number: 7778846Abstract: Transition probability sequencing models and metrics are derived from healthcare claims data to identify potentially fraudulent or abusive practices, providers, doctors, clients, or other entities. Healthcare reimbursement claims from hospitals, skilled nursing facilities, doctors, etc., are processed to identify sequences of states, and transition probability metrics are determined from frequency information pertaining to the states. The metrics can these be further analyzed in predictive or rule based models, or other tools.Type: GrantFiled: July 23, 2007Date of Patent: August 17, 2010Assignee: Fair Isaac CorporationInventors: Nallan Suresh, Jean de Traversay, Hyma Gollamudi, Krassimir G. Ianakiev, Anu Kumar Pathria, Michael K. Tyler
-
Publication number: 20080249820Abstract: Transaction-based behavioral profiling, whereby the entity to be profiled is represented by a stream of transactions, is required in a variety of data mining and predictive modeling applications. An approach is described for assessing inconsistency in the activity of an entity, as a way of detecting fraud and abuse, using service-code information available on each transaction. Inconsistency is based on the concept that certain service-codes naturally co-occur more than do others. An assessment is made of activity consistency looking at the overall activity of an individual entity, as well as looking at the interaction of entities. Several approaches for measuring consistency are provided, including one inspired by latent semantic analysis as used in text analysis. While the description is in the context of fraud detection in healthcare, the techniques are relevant to application in other industries and for purposes other than fraud detection.Type: ApplicationFiled: April 16, 2008Publication date: October 9, 2008Inventors: Anu K. Pathria, Andrea L. Allmon, Jean de Traversay, Krassimir G. Ianakiev, Nallan C. Suresh, Michael K. Tyler
-
Patent number: 7418431Abstract: A system, computer program product, and method provide for reason driven data analysis in a web-based system that is configurable to various types of data and environments. The computer program product provides for navigation of a report tree of reports that are hierarchically organized with respect to reasons derived from an analysis of transactional data in a database. A frame based interface provides for easy and flexible navigation and configuration of the reports and other features. A configuration file is used to rapidly develop and customize the web-based system. Case management functionality is included to allow for management of cases being reviewed using the system.Type: GrantFiled: September 27, 2000Date of Patent: August 26, 2008Assignee: Fair Isaac CorporationInventors: Craig A. Nies, Jean de Traversay, Arati S. Deo, Anu K. Pathria, Louis S. Biafore
-
Patent number: 7379880Abstract: Computer implemented processes and software products generate profiles of entities, such as providers, clients, merchants and customers, and entities comprising interacting pairs of entities. The processes including deriving direct profiles from transaction data pertaining to an entity and enhancing the profile of one entity using the profile of another entity. Parallel and serial applications of the derive and enhance processes on various individual and multiple entites yields enhanced profiles that powerfully describe the interactions and relationship of the entities to each other, and between their members.Type: GrantFiled: June 28, 2000Date of Patent: May 27, 2008Assignee: Fair Isaac CorporationInventors: Anu K. Pathria, Louis S. Biafore, Jean de Traversay, Arati S. Deo, Ho Ming Luk
-
Publication number: 20070271120Abstract: Transition probability sequencing models and metrics are derived from healthcare claims data to identify potentially fraudulent or abusive practices, providers, doctors, clients, or other entities. Healthcare reimbursement claims from hospitals, skilled nursing facilities, doctors, etc., are processed to identify sequences of states, and transition probability metrics are determined from frequency information pertaining to the states. The metrics can these be further analyzed in predictive or rule based models, or other tools.Type: ApplicationFiled: July 23, 2007Publication date: November 22, 2007Inventors: Nallan Suresh, Jean de Traversay, Hyma Gollamudi, Krassimir Ianakiev, Anu Pathria, Michael Tyler
-
Patent number: 7263492Abstract: Transition probability sequencing models and metrics are derived from healthcare claims data to identify potentially fraudulent or abusive practices, providers, doctors, clients, or other entities. Healthcare reimbursement claims from hospitals, skilled nursing facilities, doctors, etc., are processed to identify sequences of states, and transition probability metrics are determined from frequency information pertaining to the states. The metrics can these be further analyzed in predictive or rule based models, or other tools.Type: GrantFiled: February 15, 2002Date of Patent: August 28, 2007Assignee: Fair Isaac CorporationInventors: Nallan C Suresh, Jean de Traversay, Hyma Gollamudi, Krassimir G Ianakiev, Anu K Pathria, Michael K Tyler
-
Publication number: 20030158751Abstract: Fraud and abuse detection in an entity's payment coding practices includes the ability to search for fraud at all levels of the hierarchical coded payment system within the context of an unsupervised model. The model uses variables derived and profiles created at any level or at all levels of the hierarchical coded payment system to create a comprehensive description of the payment coding activities submitted by the entity. That description is compared with other peer entities to determine unusual and potentially inappropriate activity. The profiles created may themselves be utilized for purposes other than the detection of fraud and abuse.Type: ApplicationFiled: November 15, 2002Publication date: August 21, 2003Inventors: Nallan C. Suresh, Jean de Traversay, Hyma Gollamudi, Anu K. Pathria, Michael K. Tyler