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1. 发明专利

AU2021200862A1 SYSTEMS AND METHODS FOR PROCESSING CLAIMS 未知
公开(公告)号：AU2021200862A1
公开(公告)日：2021-09-02
申请号：AU2021200862
申请日：2021-02-11
申请人： DATAINFOCOM USA INC
发明人： WANG WENSU , WANG CHUN , WEI ZHIYONG , CHENG WANLI , GAO KUIKUI , SUN YUHAO , NAZIR MUBBASHIR , THIELKE RICK
IPC分类号： G06Q40/08
摘要： Methods, systems and apparatuses, including computer programs encoded on computer storage media, are provided for processing claims using both unstructured and structured policy documents, claim data, and customer and policy data. Policy rules, benefit calculation formulae, necessary data points, and benefit requirements are extracted from policy documents using NLP and AI techniques. Unstructured claim data is converted to a structured form using natural language processing, information extraction, and AI techniques to identify and extract relevant information, including values for the data points and benefit conditions, then the combined structured data and converted unstructured data is processed to get all values for the data points and applicable benefit conditions. The relevant claim information is then further processed against the policy rules for eligibility assessment and benefit calculation formulae to generate a benefit payment amount and entitled additional benefits. RECEIVE CLAIM 304 INFORMATION EXTRACT CLAIM 306 INFORMATION DETERMINE CLAIM TYPE 308 IDENTIFY APPLICABLE ASSESS AND ANALYZE CLAIM INFORMATION 316 AGAINST POLICIES TO DETERMINE BENEFITS CALCULATE BENEFIT 320 PAY CUSTOMER 324

2. 发明专利

AU2022204188A1 SYSTEMS AND METHODS FOR PROCESSING CLAIMS 未知
公开(公告)号：AU2022204188A1
公开(公告)日：2022-07-21
申请号：AU2022204188
申请日：2022-06-15
申请人： DATAINFOCOM USA INC
发明人： WANG WENSU , WANG CHUN , WEI ZHIYONG , CHENG WANLI , GAO KUIKUI , SUN YUHAO , NAZIR MUBBASHIR , THIELKE RICK
IPC分类号： G06Q40/08 , G06F16/93 , G06F40/295 , G06F40/40 , G06N3/02 , G06Q10/10 , G06Q30/00 , G06Q40/00 , G06V30/20 , G06V30/242 , G06V30/244 , G06V30/262 , G16H10/60
摘要： Methods, systems, and apparatuses, including computer programs encoded on computer storage media, are provided for processing claims using both unstructured and structured policy documents, claim data, and customer and policy data, in conjunction with automatic requests for human intervention. Policy rules, benefit calculation formulae, necessary data points, and benefit requirements are extracted from policy documents using NLP and Al techniques. Unstructured claim data is converted to a structured form using natural language processing, information extraction, and Al techniques to identify and extract relevant information, including values for the data points and benefit conditions, then the combined structured data and converted unstructured data is processed to get all values for the data points and applicable benefit conditions. The relevant claim information is then further processed against the policy rules for eligibility assessment and benefit calculation formulae to generate a benefit payment amount and entitled additional benefits. RECEIVE CLAIM 304 INFORMATION EXTRACT CLAIM 306 INFORMATION DETERMINE CLAIM TYPE 308 IDENTIFY APPLICABLE ASSESS AND ANALYZE CLAIM INFORMATION 316 AGAINST POLICIES TO DETERMINE BENEFITS CALCULATE BENEFIT 320 PAY CUSTOMER 324

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