Nicholas F Howell

US Patent:

8126824, Feb 28, 2012

Filed:

Dec 13, 2010

Appl. No.:

12/966978

Inventors:

Michael Scott Hartley - Atlanta GA, US
Leana Rachelle Wallace - San Francisco CA, US
Lisa Marie Henning - Denver CO, US
Nicholas Francisco Howell - San Marino CA, US
Sanjay Mathur - Redwood City CA, US

Assignee:

Accenture Global Services Limited - Dublin

International Classification:

G06F 17/00

US Classification:

706 12, 713186

Abstract:

A payment integrity system that processes data, including data associated with a biometric technology. The system includes a discovery module to receive insurance records from a source of data, which includes the data associated with the biometric technology, the records providing information that pertain to at least one transaction. The discovery module includes a query component and an artificial intelligence engine to process the records to identify a second subset of the records having anomalous information, and provide a second analysis output indicative of the second subset. The system also includes an audit module to determine whether to instruct the artificial intelligence engine to analyze the records according to the outputs. The system facilitates resolution of a claim payment based on the first analysis output and the second analysis output.

US Patent:

8583570, Nov 12, 2013

Filed:

Feb 13, 2012

Appl. No.:

13/371866

Inventors:

Michael Scott Hartley - Atlanta GA, US
Leana Rachelle Wallace - San Francisco CA, US
Lisa Marie Henning - Denver CO, US
Nicholas Francisco Howell - San Marino CA, US
Sanjay Mathur - Redwood City CA, US

Assignee:

Accenture Global Services Limited - Dublin

International Classification:

G06N 5/00

US Classification:

706 12, 706 45

Abstract:

A payment integrity system that processes data, including data associated with a biometric technology. The system includes a discovery module to receive insurance records from a source of data, which includes the data associated with the biometric technology, the records providing information that pertain to at least one transaction. The discovery module includes a query component and an artificial intelligence engine to process the records to identify a second subset of the records having anomalous information, and provide a second analysis output indicative of the second subset. The system also includes an audit module to determine whether to instruct the artificial intelligence engine to analyze the records according to the outputs. The system facilitates resolution of a claim payment based on the first analysis output and the second analysis output.

US Patent:

20060200407, Sep 7, 2006

Filed:

Mar 2, 2005

Appl. No.:

11/070739

Inventors:

Michael Hartley - Atlanta GA, US
Leana Wallace - San Francisco CA, US
Lisa Henning - Denver CO, US
Nicholas Howell - San Marino CA, US
Sanjay Mathur - Redwood City CA, US

Assignee:

Accenture Global Services GmbH - Schaffhausen

International Classification:

G06Q 40/00

US Classification:

705040000

Abstract:

Methods and systems for identifying and resolving payment integrity issues are provided. Analytic techniques that may include a query component, an artificial intelligence engine, and a text mining component are integrated into a payment integrity system. One or more of the analysis components provide information from a source transaction system to an audit module. The audit module utilizes the outputs from the analysis components to resolve whether or not a claim payment was overpaid or underpaid. The audit module may subsequently instruct one of the analysis components to further analyze information from the source transaction system in accordance with previously provided information from another analysis component. The audit module may also subsequently instruct the recovery and adjustments module to act upon the result of the audit. The payment integrity system may also receive an indication of a provider claim dispute and resolve the dispute. The payment integrity system may receive a notification of an unsolicited reimbursement (e.g., refund or repayment) from a provider, adjust the associated claim, access data for corresponding claims having a similar characteristic, and audit the corresponding claims. The recovery and adjustments module utilizes the outputs from the audit module to complete the process of recovering overpayments or adjusting claims for underpayment.

US Patent:

20110054925, Mar 3, 2011

Filed:

Aug 25, 2009

Appl. No.:

12/547110

Inventors:

Rayid GHANI - Chicago IL, US
Leana R. WALLACE - San Francisco CA, US
Michael S. IRISH - San Francisco CA, US
Ajay K. EASO - Chicago IL, US
Mohit KUMAR - Chicago IL, US
Dmitriy FEFERMAN - Chicago IL, US
Nicholas F. HOWELL - San Marino CA, US
Lindsey J. LIZARDI - State College PA, US
Laura J. JANTZEN - Greenwood Village CO, US

International Classification:

G06Q 50/00

US Classification:

705 2

Abstract:

Methods and systems for processing claims (e.g., healthcare insurance claims) are described. For example, prior to payment of an unpaid claim, a prediction is made as to whether or not an attribute specified in the claim is correct. Depending on the prediction results, the claim can be flagged for an audit. Feedback from the audit can be used to update the prediction models in order to refine the accuracy of those models.

US Patent:

20140249865, Sep 4, 2014

Filed:

May 16, 2014

Appl. No.:

14/280065

Inventors:

- Dublin, IE
Leana R. Wallace - San Francisco CA, US
Michael S. Irish - San Francisco CA, US
Ajay K. Easo - Chicago IL, US
Mohit Kumar - Chicago IL, US
Dmitriy Feferman - Chicago IL, US
Nicholas F. Howell - San Marino CA, US
Lindsey J. Lizardi - State College PA, US
Laura J. Jantzen - Greenwood Village CO, US

Assignee:

Accenture Global Services Limited - Dublin

International Classification:

G06Q 40/08
G06N 99/00

US Classification:

705 4

Abstract:

Methods and systems for processing claims (e.g., healthcare insurance claims) are described. For example, prior to payment of an unpaid claim, a prediction is made as to whether or not an attribute specified in the claim is correct. Depending on the prediction results, the claim can be flagged for an audit. Feedback from the audit can be used to update the prediction models in order to refine the accuracy of those models.