US 12,437,851 B1
Methods, systems, and computer program products for selecting criteria subsets for performing a medical necessity review for a patient care plan
Carol Cheng, Seattle, WA (US); Ian Gilbert, Arlington, MA (US); Changsung Moon, Kirkland, WA (US); Feng Yi, San Mateo, CA (US); Feili Yu, Shoreline, WA (US); and Fan Zhou, Redmond, WA (US)
Assigned to OPTUM, INC., Minnetonka, MN (US)
Filed by Optum, Inc., Minnetonka, MN (US)
Filed on Mar. 24, 2023, as Appl. No. 18/189,485.
Int. Cl. G16H 20/00 (2018.01); G16H 10/60 (2018.01); G16H 40/20 (2018.01)
CPC G16H 20/00 (2018.01) [G16H 10/60 (2018.01); G16H 40/20 (2018.01)] 20 Claims
OG exemplary drawing
 
1. A method comprising:
receiving, by one or more processors, input information associated with a health record of a patient, the input information comprising information associated with a plurality of input variables;
embedding, by the one or more processors, the information associated with the plurality of input variables to generate a plurality of input variable vectors, respectively;
aggregating, by the one or more processors, the plurality of input variable vectors to generate a patient health record vector;
generating, by the one or more processors and using a knowledge graph, a first ranking of a plurality of subsets of criteria used for determining an appropriateness of a care plan for the patient based on the patient health record vector;
generating, by the one or more processors and using an artificial intelligence engine, a second ranking of the plurality of subsets of the criteria used for determining the appropriateness of the care plan for the patient based on the patient health record vector; and
generating, by the one or more processors, a final ranking of the plurality of subsets of the criteria used for determining the appropriateness of the care plan for the patient based on the first ranking and the second ranking.