Abstract: A system and method to authorize requests for procedures or medical claim requests is described. In one aspect, datasets from multiple data sources, including historical authorizations associated with various medical claims, are processed. The machine learning engines and the machine learning models are trained based on the received data. Simultaneously, real-time authorization requests are received and analyzed from secondary data sources. Each request is split into service requests based on second attributes, which include identifiers linked to services. The services are encoded using fixed-length encoding, and unique numeric identifiers are assigned to categorical variables. For each encoded service request, contexts, actions, and decisions are determined by comparing the first attributes of historical authorization requests with the second attributes of real-time requests.

Abstract: Configurations of a system and a method for a dynamic trust-based authorization system (DTBAS), are described. In one aspect, the DTBAS may implement an execution of operations of multiple engines, models, framework, circuits, code, etc., for dynamically authorizing a request for a service or an operation. The DTBAS, when deployed in a managing entity, may receive a request from a managed entity to execute an operation or task. Based on parameters or attributes associated with the managed entity, the DTBAS may execute operations to evaluate a trust score. Based on the evaluated trust score, the DTBAS may compute a weight decision matrix that may include multiple weights associated with the managed entity. Based on the computed weight decision matrix and the evaluated trust score, the DTBAS may authorize or deny the execution of the requested operation.

Abstract: A system and method to authorize requests for procedures or medical claim requests is described. In one aspect, datasets from multiple data sources, including historical authorizations associated with various medical claims, are processed. The machine learning engines and the machine learning models are trained based on the received data. Simultaneously, real-time authorization requests are received and analyzed from secondary data sources. Each request is split into service requests based on second attributes, which include identifiers linked to services. The services are encoded using fixed-length encoding, and unique numeric identifiers are assigned to categorical variables. For each encoded service request, contexts, actions, and decisions are determined by comparing the first attributes of historical authorization requests with the second attributes of real-time requests.

Abstract: Configurations of a system and a method for a dynamic trust-based authorization system (DTBAS), are described. In one aspect, the DTBAS may implement an execution of operations of multiple engines, models, framework, circuits, code, etc., for dynamically authorizing a request for a service or an operation. The DTBAS, when deployed in a managing entity, may receive a request from a managed entity to execute an operation or task. Based on parameters or attributes associated with the managed entity, the DTBAS may execute operations to evaluate a trust score. Based on the evaluated trust score, the DTBAS may compute a weight decision matrix that may include multiple weights associated with the managed entity. Based on the computed weight decision matrix and the evaluated trust score, the DTBAS may authorize or deny the execution of the requested operation.

Abstract: System and method for optimizing outcomes for healthcare entities, are described. In one aspect, the system includes an implementation of an optimization framework of machine learning engines, models, multiple sources of information or data. The machine learning engines may cooperatively collaborate with the models and execute operations on the data from the diverse data sources. In response to execution of the operations, the machine learning engines of the system may identify and/or determine multiple outcomes that may be optimized. The results of the execution of the operations by the machine learning engines of the system may provision analyzing different scenarios, analyzing recommendations, and take actionable steps based on the results of the analysis. Upon implementing the actionable steps, the outcomes for the healthcare entities may be optimized.