US 11,537,913 B2Granted

Artificial intelligence automation for enrollment

AssigneeAetna Inc.

InventorsRajesh Johnson, Mrinal M. Joglekar, Jamie L. Potter-Watkins

Life of this patent

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Abstract

A system and method are disclosed for detecting anomalies in input data. The input data can include enrollment information for members of a health insurance product offered by an insurance carrier. A system is configured to process one or more parameters associated with the input data to detect whether an anomaly is indicated in the input data. At least one artificial intelligence algorithm is configured to compare a parameter in the one or more parameters to a range defined by a moving average. When an anomaly is detected, the processing can be paused and manual intervention can be facilitated. When no anomaly is detected, a database is updated based on the input data. In an embodiment, the input data is an ANSI 834 format file that includes a plurality of membership records, and the one or more parameters are derived from statistics related to the membership records.

Claims14

Dependent claims

A system for detecting anomalies, the system comprising:

a memory storing input data in a first format;
and
one or more processors associated with a health insurance carrier and configured to:
process one or more parameters associated with the input data to detect whether an anomaly is indicated in the input data, wherein at least one artificial intelligence algorithm is configured to compare a parameter in the one or more parameters to a range defined by a moving average;
and
pause the processing in response to detecting the anomaly, or
update, responsive to not detecting the anomaly, a database based on the input data,
wherein the input data is one of:
an ANSI 834 format file;
or
an ANSI 837 format file;
and
wherein the one or more processors are further configured to:
receive the input data from a plan sponsor via a network;
generate a data structure associated with the input data that includes at least one of the one or more parameters processed by the at least one artificial intelligence algorithm;
convert the input data to a second format based, at least in part, on one or more validation rules;
and
store the input data in the second format in the data structure.

15 more elements

Dependencies are inferred from the claim text.

Facts

Application: 16/816,996Filed 12 Mar 2020
Published: US 2021/0287113 A116 Sep 2021
Granted: 27 Dec 2022
Term ends: Not estimatedThe source records don’t support an estimate.

Classification8 codes

G06N 5/04
Computing arrangements using knowledge-based models: inference or reasoning models
G06F 16/2379
Updating: updates performed during online database operations; commit processing
G06F 16/258
Integrating or interfacing systems involving database management systems: data format conversion from or to a database
G06N 20/00
Machine learning