CPC G16H 20/10 (2018.01) [G06F 16/283 (2019.01); G06N 20/00 (2019.01); G16H 40/20 (2018.01)] | 20 Claims |
8. A method for use in dispensing one or more prescription drugs, said method performed by a claim analysis device and a pharmacy fulfillment device in communication with a data warehouse system and a claim processing system, the data warehouse system including historical claims including a set of historical claim features and a historical claim status, the claim processing system including pending claims including a set of pending claim features, the pharmacy fulfillment device configured to dispense a prescription drug, the claim analysis device including a processor and a memory, said method comprising:
extracting, by the claim analysis device, subsets of historical claim features from a subset of historical claims received from the data warehouse system, wherein each of the subset of historical claims has a corresponding historical claim status indicating that the claim has been successfully processed;
extracting, by the claim analysis device, a subset of pending claim features from a pending claim received from the claim processing system;
applying, by the claim analysis device, a binarization process on the extracted subsets of historical claim features to obtain a binarized training feature set for the subset of historical claims;
applying, by the claim analysis device, the binarization process on the extracted subset of pending claim features to obtain a binarized pending feature set for the pending claim;
calculating, by the claim analysis device, an aggregate distance between the binarized pending feature set and the binarized training feature set for the subset of historical claims;
identifying, by the claim analysis device, from the subset of historical claims, a historical claim associated with the least aggregate distance as a predictive historical claim;
determining, by the claim analysis device, that a billing attribute of the predictive historical claim matches a corresponding billing attribute of the pending claim;
validating, by the claim analysis device, the pending claim and transmitting, to the pharmacy fulfillment device, an instruction for dispensing the prescription drug in accordance with the pending claim; and
dispensing, by the pharmacy fulfillment device, the prescription drug based on the instruction from the claim analysis device.
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