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44 results about "Risk adjustment" patented technology

Automated Healthcare Risk Management System Utilizing Real-time Predictive Models, Risk Adjusted Provider Cost Index, Edit Analytics, Strategy Management, Managed Learning Environment, Contact Management, Forensic GUI, Case Management And Reporting System For Preventing And Detecting Healthcare Fraud, Abuse, Waste And Errors

InactiveUS20140081652A1Facilitate and enhance and implement multiple investigator decisionResource optimizationFinancePayment architectureLower riskMedical education
The Automated Healthcare Risk Management System is a real-time Software as a Service application which interfaces and assists investigators, law enforcement and risk management analysts by focusing their efforts on the highest risk and highest value healthcare payments. The system's Risk Management design utilizes real-time Predictive Models, a Provider Cost Index, Edit Analytics, Strategy Management, a Managed Learning Environment, Contact Management, Forensic GUI, Case Management and Reporting System for individually targeting, identifying and preventing fraud, abuse, waste and errors prior to payment. The Automated Healthcare Risk Management System analyzes hundreds of millions of transactions and automatically takes actions such as declining or queuing a suspect payment. Claim payment risk is optimally prioritized through a Managed Learning environment, from high risk to low risk for efficient resolution by investigators.
Owner:RISK MANAGEMENT SOLUTIONS

System and Method for Managing Derivative Instruments

InactiveUS20140040163A1Efficiently and transparently adjustFinanceCredit limitLibrary science
The present invention is a system and method for providing improved functionality for management of derivative instruments. The improved system includes functionality implementing single interest rate sale sessions initiated either as a result of market conditions or a user request, risk adjustment sales to allow users to balance portfolio risks, consolidated sweeps to more efficiently allow a user to manage an investment swap portfolio, and credit limit clearance functionality to improve the management of credit limits associated with users and clearance facilities.
Owner:TRUEEX GROUP LLC

System and method for analyzing audit risk of claims-based submissions for medicare advantage risk adjustment

Systems and methods have been developed that provide for the examination of data available on members of a Plan and based on the examined data, and on each reported ailment for a member, a determination is made as to the risk level such member presents to the Plan. This risk level is a measure of how likely it is that an assigned ailment identified from a claim will be found to be in error during an official CMS audit of member medical records for a particular year. The examination is made without necessarily reviewing actual physician's charts.
Owner:CENSEO HEALTH

Credit line measuring and calculating method and equipment and medium

The invention discloses a credit line measuring and calculating method and equipment and a medium. The scheme comprises the following steps: determining a default rate of an enterprise, and constructing a first function; incorporating the first function into a risk adjustment capital return rate model to obtain a first credit line enabling a risk adjustment capital return rate of a commercial bank to be maximum under a preset condition; obtaining modeling indexes related to a preset general scoring model, performing data cleaning, feature screening and model training on sample features corresponding to the modeling indexes, and determining a performance prediction probability of the general scoring model; converting the performance prediction probability of the general scoring model into a scoring rating result of the enterprise, and determining a second credit line of the enterprise according to the scoring rating result of the enterprise and a credit rating amplification coefficient of the enterprise; and comparing and analyzing the first credit line and the second credit line based on credit restrictive conditions to obtain a comparison and analysis result, and determining a credit line of the enterprise according to the comparison and analysis result.
Owner:天元大数据信用管理有限公司
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