US 12,266,018 B1
Use determination risk coverage datastructure for on-demand and increased efficiency coverage detection and rebalancing apparatuses, processes and systems
Anthony Miller, Minneapolis, MN (US); David Dickey, Minneapolis, MN (US); Henning Chiv, Castro Valley, CA (US); Matthew Chock, Eagan, MN (US); Glen Eiden, Forest Lake, MN (US); Trevor Fast, San Francisco, CA (US); Shawn Wagoner, Minneapolis, MN (US); Matthew Wiandt, Bloomington, MN (US); Jessica Zeaske, Minneapolis, MN (US); Nels Marcus Thygeson, San Rafael, CA (US); Charley Hastings, Cape Coral, FL (US); Jason Haupt, Maple Grove, MN (US); Mark Peterson, Eagan, MN (US); Maxwell L. Peterson, Minneapolis, MN (US); Benjamin Kowitt, Philadelphia, PA (US); and Thomas Anton Klun, Minneapolis, MN (US)
Assigned to Bind Benefits, Inc., Minneapolis, MN (US)
Filed by Bind Benefits, Inc., Minneapolis, MN (US)
Filed on Jul. 11, 2022, as Appl. No. 17/862,333.
Application 17/862,333 is a continuation in part of application No. 16/659,444, filed on Oct. 21, 2019.
Application 17/862,333 is a continuation in part of application No. 16/659,438, filed on Oct. 21, 2019.
Application 17/862,333 is a continuation in part of application No. 16/659,429, filed on Oct. 21, 2019, granted, now 11,790,454.
Application 17/862,333 is a continuation in part of application No. 15/632,052, filed on Jun. 23, 2017.
Application 17/862,333 is a continuation in part of application No. 15/631,961, filed on Jun. 23, 2017, granted, now 11,663,670.
Claims priority of provisional application 63/220,991, filed on Jul. 12, 2021.
Claims priority of provisional application 63/220,993, filed on Jul. 12, 2021.
Claims priority of provisional application 63/220,988, filed on Jul. 12, 2021.
Claims priority of provisional application 63/220,992, filed on Jul. 12, 2021.
Claims priority of provisional application 63/220,986, filed on Jul. 12, 2021.
Claims priority of provisional application 62/807,711, filed on Feb. 19, 2019.
Claims priority of provisional application 62/748,518, filed on Oct. 21, 2018.
Claims priority of provisional application 62/524,188, filed on Jun. 23, 2017.
Claims priority of provisional application 62/510,215, filed on May 23, 2017.
Claims priority of provisional application 62/446,810, filed on Jan. 16, 2017.
Int. Cl. G06Q 40/08 (2012.01); G06Q 10/067 (2023.01)
CPC G06Q 40/08 (2013.01) [G06Q 10/067 (2013.01)] 18 Claims
OG exemplary drawing
 
1. A system comprising:
one or more processors and at least one memory storing processor-executable instructions, that, when executed by any one of the one or more processors, cause the one or more processors to perform operations comprising:
obtaining an episodes build request datastructure, the episodes build request datastructure structured including a data field for identifying an encounter type;
comparing the encounter type with a value specified in a corresponding data field of a set of available encounter datastructures;
selecting an anchor encounter datastructure, in which the value specified in the corresponding data field of the anchor encounter datastructure matches the encounter type;
determining analysis window rules associated with the encounter type, the analysis window rules specifying at least one of: a pre- window time period, a post-window time period, a time period length;
determining an analysis window for the anchor encounter datastructure using the analysis window rules and a service date value specified in a corresponding data field of the anchor encounter datastructure;
determining an enrollee identifier value specified in a corresponding data field of the anchor encounter datastructure;
determining a set of other encounter datastructures for the anchor encounter datastructure, in which a service date value specified in a corresponding data field of each other encounter datastructure is in the analysis window for the anchor encounter datastructure, and in which the determined enrollee identifier value matches an enrollee identifier value specified in a corresponding data field of each other encounter datastructure;
determining a props ratio relevance function associated with the encounter type, the props ratio relevance function structured classifying claim codes as either relevant or irrelevant to the encounter type;
determining an encounter relevance classification for each other encounter datastructure in the set of other encounter datastructures using the props ratio relevance function;
determining a set of accessory encounter datastructures for the anchor encounter datastructure, the set of accessory encounter datastructures corresponding to other encounter datastructures for the anchor encounter datastructure classified as relevant based on the encounter relevance classification; and
generating an episode datastructure structured including a set of data fields for identifying: the anchor encounter datastructure, the set of accessory encounter datastructures, and the encounter type.