公开(公告)号：US20210224919A1

公开(公告)日：2021-07-22

申请号：US17013418

申请日：2020-09-04

Applicant: Pearl Inc.

Inventor： Joshua Alexander Tabak ,  Adam Michael Wilbert ,  Mustafa Alammar ,  Rohit Sanjay Annigeri ,  Cambron Neil Carter

IPC: G06Q40/08 ,  G16H30/20 ,  G16H15/00 ,  H04L9/32 ,  G06K9/62 ,  H04L29/06

Abstract: Systems and methods are described for automatically identifying fraud, waste or abuse in health insurance claims submitted to insurance companies by healthcare providers. Insurance claim information and at one image associated with the insurance claim may be received, where the image has been submitted by a healthcare provider to an insurance carrier as supporting evidence of a medical service performed by the healthcare provider. The system may generate a digital signature representing the image, then may compare the digital signature generated for the image to previously generated digital signatures of other images that have been submitted in association with other insurance claims. The system may then determine a likelihood that the given insurance claim is associated with fraud, waste or abuse, based in part on whether the digital signature is identical or close to one or more of the previously generated digital signatures.

公开(公告)号：US11055789B1

公开(公告)日：2021-07-06

申请号：US17013418

申请日：2020-09-04

Applicant: Pearl Inc.

Inventor： Joshua Alexander Tabak ,  Adam Michael Wilbert ,  Mustafa Alammar ,  Rohit Sanjay Annigeri ,  Cambron Neil Carter

IPC: G06Q40/08 ,  G16H15/00 ,  G16H30/20 ,  H04N21/643 ,  H04L9/32 ,  G06N20/00 ,  H04L29/06 ,  G06K9/62

Abstract: Systems and methods are described for automatically identifying fraud, waste or abuse in health insurance claims submitted to insurance companies by healthcare providers. Insurance claim information and at one image associated with the insurance claim may be received, where the image has been submitted by a healthcare provider to an insurance carrier as supporting evidence of a medical service performed by the healthcare provider. The system may generate a digital signature representing the image, then may compare the digital signature generated for the image to previously generated digital signatures of other images that have been submitted in association with other insurance claims. The system may then determine a likelihood that the given insurance claim is associated with fraud, waste or abuse, based in part on whether the digital signature is identical or close to one or more of the previously generated digital signatures.

公开(公告)号：US10984529B2

公开(公告)日：2021-04-20

申请号：US16562285

申请日：2019-09-05

Applicant: Pearl Inc.

Inventor： Cambron Neil Carter ,  Nandakishore Puttashamachar ,  Rohit Sanjay Annigeri ,  Joshua Alexander Tabak ,  Nishita Kailashnath Sant ,  Ophir Tanz ,  Adam Michael Wilbert ,  Mustafa Alammar

IPC: G06T7/00 ,  G16H30/40 ,  G06T11/20

Abstract: Systems and methods are provided for presenting an interactive user interface that visually marks locations within a radiograph of one or more dental pathologies, anatomies, anomalies or other conditions determined by automated image analysis of the radiograph by a number of different machine learning models. Annotation data generated by the machine learning models may be obtained, and one or more visual bounding shapes generated based on the annotation data. A user interface may present at least a portion of the radiograph's image data, along with display of the visual bounding shapes appearing to be overlaid over the at least a portion of the image data to visually mark the presence and location of a given pathology or other condition.