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US 2021/0200896 A1Published application
Programmatic determinations using decision trees generated from relational database entries
AssigneeUnitedHealth Group Incorporated
InventorsFrank W. Lilja, Aaron Christopher Wacker, Carl J. Boudreau, Danh Q. Lam
Life of this patent
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Abstract
Methods, apparatus, systems, computing devices, computing entities, and/or the like for programmatic methodologies for determining and providing prior authorization requirements in a way that facilitates inputting information/data, updating information/data, searching information/data, viewing information/data, reporting information/data, and analyzing information/data while being broadly accessible to disparate systems.
Claims21
A computer-implemented method comprising:
- providing, by one or more processors, an interface enabling navigation of (a) one or more first prior authorization requirements and (b) one or more second prior authorization requirements, wherein (a) the one or more first prior authorization requirements correspond to a first medical code, and (b) the one or more second prior authorization requirements correspond to a second medical code;
- populating, by the one or more processors, (a) one or more fields of a first row of a relational database table with at least a portion of the one or more first prior authorization requirements and (b) one or more fields of a second row of the relational database table with at least a portion of the one or more first prior authorization requirements;
- populating, by the one or more processors, (a) one or more fields of a third row of the relational database table with at least a portion of the one or more second prior authorization requirements and (b) one or more fields of a fourth row of the relational database table with at least a portion of the one or more second prior authorization requirements;
- generating, by the one or more processors, a first decision tree for the first medical code based at least in part on the first row and the second row;
- generating, by the one or more processors, a second decision tree for the second medical code based at least in part on the third row and the fourth row;
- and
- receiving, by the one or more processors, a prior authorization request for the first medical code;
- responsive to receiving the prior authorization request for the first medical code, traversing, by the one or more processors, the first decision tree to generate a prior authorization response;
- providing, by the one or more processors, the prior authorization response.
6 more elements
A computer program product comprising a non-transitory computer readable medium having computer program instructions stored therein, the computer program instructions when executed by a processor, cause the processor to:
- provide an interface enabling navigation of (a) one or more first prior authorization requirements and (b) one or more second prior authorization requirements, wherein (a) the one or more first prior authorization requirements correspond to a first medical code, and (b) the one or more second prior authorization requirements correspond to a second medical code;
- populate (a) one or more fields of a first row of a relational database table with at least a portion of the one or more first prior authorization requirements and (b) one or more fields of a second row of the relational database table with at least a portion of the one or more first prior authorization requirements;
- populate (a) one or more fields of a third row of the relational database table with at least a portion of the one or more second prior authorization requirements and (b) one or more fields of a fourth row of the relational database table with at least a portion of the one or more second prior authorization requirements;
- generate a first decision tree for the first medical code based at least in part on the first row and the second row;
- generate a second decision tree for the second medical code based at least in part on the third row and the fourth row;
- and
- receive a prior authorization request for the first medical code;
- responsive to receiving the prior authorization request for the first medical code, traverse the first decision tree to generate a prior authorization response;
- and
- provide the prior authorization response.
7 more elements
A computing system comprising a non-transitory computer readable storage medium and one or more processors, the computing system configured to:
- provide an interface enabling navigation of (a) one or more first prior authorization requirements and (b) one or more second prior authorization requirements, wherein (a) the one or more first prior authorization requirements correspond to a first medical code, and (b) the one or more second prior authorization requirements correspond to a second medical code;
- populate (a) one or more fields of a first row of a relational database table with at least a portion of the one or more first prior authorization requirements and (b) one or more fields of a second row of the relational database table with at least a portion of the one or more first prior authorization requirements;
- populate (a) one or more fields of a third row of the relational database table with at least a portion of the one or more second prior authorization requirements and (b) one or more fields of a fourth row of the relational database table with at least a portion of the one or more second prior authorization requirements;
- generate a first decision tree for the first medical code based at least in part on the first row and the second row;
- generate a second decision tree for the second medical code based at least in part on the third row and the fourth row;
- and
- receive a prior authorization request for the first medical code;
- responsive to receiving the prior authorization request for the first medical code, traverse the first decision tree to generate a prior authorization response;
- and
- provide the prior authorization response.
7 more elements
Dependencies are inferred from the claim text.