Dynamic topological system and method for efficient claims processing

Abstract

A dynamic topological system and method for efficient claims processing are provided. The dynamic topological system and method for efficient claims processing may be used in a healthcare system. The dynamic topological system and method for efficient claims processing is easily extensible, maintainable and extendable.

1 . A healthcare claims processing apparatus, comprising:
 a computer system having a processor and a memory;   a database associated with the computer system that stores one of more claims records;   a claims processing component that generates a compressed representation of the one of more claims records, the compressed representation having a plurality of nodes which with a claim record is associated, partitions the compressed representation into one or more neighborhood of nodes and determines, using a classifier, a status of a particular claim, wherein the status is one of denied, overpaid and underpaid.   
     
     
         2 . The apparatus of  claim 1 , wherein the compressed representation is a simplical complex. 
     
     
         3 . The apparatus of  claim 2 , wherein the claims processing component converts the one of more claims records into a feature matrix before generating the compressed representation of the one of more claims records. 
     
     
         4 . The apparatus of  claim 1 , wherein the claims processing component trains one or more classifiers for each neighborhood of nodes. 
     
     
         5 . The apparatus of  claim 4 , wherein the claims processing component selects a best classifier from the trained classifiers for a particular neighborhood of nodes wherein the particular claim is associated with the particular neighborhood of nodes. 
     
     
         6 . The apparatus of  claim 1 , wherein the claims processing component gathers the status of the claim and feeds back the status of the claim. 
     
     
         7 . A method for healthcare claims processing, comprising:
 obtaining one of more claims records;   generating a compressed representation of the one of more claims records, the compressed representation having a plurality of nodes which with a claim record is associated;   partitioning the compressed representation into one or more neighborhood of nodes; and   determining, using a classifier, a status of a particular claim, wherein the status is one of denied, overpaid and underpaid.   
     
     
         8 . The method of  claim 7 , wherein the compressed representation is a simplical complex. 
     
     
         9 . The method of  claim 8  further comprising converting the one of more claims records into a feature matrix before generating the compressed representation of the one of more claims records. 
     
     
         10 . The method of  claim 7 , wherein determining using the classifier further comprises training one or more classifiers for each neighborhood of nodes. 
     
     
         11 . The method of  claim 10 , wherein determining using the classifier further comprises selecting a best classifier from the trained classifiers for a particular neighborhood of nodes wherein the particular claim is associated with the particular neighborhood of nodes. 
     
     
         12 . The method of  claim 7  further comprising gathering the status of the claim and feeding back the status of the claim. 
     
     
         13 . A healthcare system, comprising:
 a computer system having a processor and a memory;   a health marketplace system hosted by the computer system;   a database associated with the computer system that stores one of more claims records;   a claims processing component that generates a compressed representation of the one of more claims records, the compressed representation having a plurality of nodes which with a claim record is associated, partitions the compressed representation into one or more neighborhood of nodes and determines, using a classifier, a status of a particular claim, wherein the status is one of denied, overpaid and underpaid.   
     
     
         14 . The system of  claim 13 , wherein the compressed representation is a simplical complex. 
     
     
         15 . The system of  claim 14 , wherein the claims processing component converts the one of more claims records into a feature matrix before generating the compressed representation of the one of more claims records. 
     
     
         16 . The system of  claim 13 , wherein the claims processing component trains one or more classifiers for each neighborhood of nodes. 
     
     
         17 . The system of  claim 16 , wherein the claims processing component selects a best classifier from the trained classifiers for a particular neighborhood of nodes wherein the particular claim is associated with the particular neighborhood of nodes. 
     
     
         18 . The system of  claim 13 , wherein the claims processing component gathers the status of the claim and feeds back the status of the claim.