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US 10,896,405 B1Granted
Systems and methods relating to health policy coverage of medical products and services
AssigneeConcert Genetics, Inc.
InventorsGillian W. Hooker, Blake S. Blackshear, Robert L. Metcalf, Marshall Cottrell, Taylor Murphy
Life of this patent
Estimating the term…
Abstract
The present disclosure, in one aspect, relates to implementing coverage outcome algorithms (COAs) to determine a coverage outcome indicating whether a medical service or product is covered by a health policy, and outputting the coverage outcome. In some embodiments, the COAs each utilize triggers associated with the medical service or product and/or coverage criteria associated with the health policy.
Claims20
A computer-implemented method for determining whether a health policy covers a genetic testing service or product, comprising:
- receiving information that indicates a genetic testing service or product and a health policy that covers certain services or products;
- determining an identifier corresponding to the genetic testing service or product based on the received information, wherein the identifier comprises a genetic testing unit (GTU) for the genetic testing service or product,
- wherein the GTU is a consistent identifier for tracking a plurality of attributes of the genetic testing service or product over time, and
- wherein determining the identifier comprising the GTU comprises using a machine learning model to match the identifier to the genetic testing service or product based on a training dataset;
- associating the determined identifier corresponding to the genetic testing service or product with a corresponding coverage outcome algorithm (COA) from among a plurality of coverage outcome algorithms (COAs), wherein each COA has associated coverage criteria for determining a coverage outcome;
- prompting, through an interactive user interface, the user with specific queries for information associated with the genetic testing service or product and/or health plan policy, wherein the queries are based on the respective coverage criteria corresponding to the COA;
- receiving user responses to the queries through the interactive user interface;
- determining, based on the user responses, a coverage outcome indicating whether the health policy covers the genetic testing service or product;
- and
- outputting the coverage outcome to the user.
7 more elements
A system, comprising:
- one or more processors;
- an interactive user interface;
- a memory device coupled to the one or more processors and storing instructions that, when executed by the one or more processors, cause the system to perform functions for determining whether a health policy covers a genetic testing service or product, and wherein the performed functions comprise:
- receiving information that indicates a genetic testing service or product and a health policy that covers certain services or products;
- determining an identifier corresponding to the genetic testing service or product based on the received information, wherein the identifier comprises a genetic testing unit (GTU) for the genetic testing service or product,
- wherein the GTU is a consistent identifier for tracking a plurality of attributes of the genetic testing service or product over time, and
- wherein determining the identifier comprising the GTU comprises using a machine learning model to match the identifier to the genetic testing service or product based on a training dataset;
- associating the determined identifier corresponding to the genetic testing service or product with a corresponding coverage outcome algorithm (COA) from among a plurality of coverage outcome algorithms (COAs), wherein each COA has associated coverage criteria for determining a coverage outcome;
- prompting, through the interactive user interface, the user with specific queries for information associated with the genetic testing service or product and/or health plan policy, wherein the queries are based on the respective coverage criteria corresponding to the COA;
- receiving user responses to the queries through the interactive user interface;
- determining, based on the user responses, a coverage outcome indicating whether the health policy covers the genetic testing service or product;
- and
- outputting the coverage outcome to the user.
10 more elements
A non-transitory computer-readable medium storing instructions that, when executed by one or more processors, cause one or more computing devices to perform functions for determining whether a health policy covers a genetic testing service or product, and wherein the performed functions comprise:
- receiving information that indicates a genetic testing service or product and a health policy that covers certain services or products;
- determining an identifier corresponding to the genetic testing service or product based on the received information, wherein the identifier comprises a genetic testing unit (GTU) for the genetic testing service or product,
- wherein the GTU is a consistent identifier for tracking a plurality of attributes of the genetic testing service or product over time, and
- wherein determining the identifier comprising the GTU comprises using a machine learning model to match the identifier to the genetic testing service or product based on a training dataset;
- associating the determined identifier corresponding to the genetic testing service or product with a corresponding coverage outcome algorithm (COA) from among a plurality of coverage outcome algorithms (COAs), wherein each COA has associated coverage criteria for determining a coverage outcome;
- prompting, through an interactive user interface, the user with specific queries for information associated with the genetic testing service or product and/or health plan policy, wherein the queries are based on the respective coverage criteria corresponding to the COA;
- receiving user responses to the queries through the interactive user interface;
- determining, based on the user responses, a coverage outcome indicating whether the health policy covers the genetic testing service or product;
- and
- outputting the coverage outcome to the user.
7 more elements
Dependencies are inferred from the claim text.