Generation from data threats and predictive application of the data models

    公开(公告)号:US10776890B1

    公开(公告)日:2020-09-15

    申请号:US15679258

    申请日:2017-08-17

    Abstract: Data threat evaluation systems and methods are described. A data model structure includes a root object query that, when executed, returns a third data subset from the plurality of data types that predate a known threat, the third data subset including data types in both the first data subset and the second data subset; and a model schema to extract, from the third data subset, data types of the first subset that predicate and indicate the threat, the model schema to produce at least an individualized data threat regression model, a script originator regression model, and a script filler data threat regression model using the extracted data types. The system may use the individualized data threat regression model, the script originator regression model, and the script filler data threat regression model back on the data set to identify potential threats. The system can be applied as a fraud, waste or abuse detector.

    Methods and systems for pharmacy modeling

    公开(公告)号:US10657480B1

    公开(公告)日:2020-05-19

    申请号:US15669741

    申请日:2017-08-04

    Abstract: Methods and systems for pharmacy modeling are described. The risk adjusted pharmacy predictive model is created from member data, claims data, and population data. This model can be used to compare the actual pharmacy performance to an expected actual pharmacy performance value, which can be used to identify pharmacies at risk or not performing to an acceptable level. The model can be used for adherence and generic drug utilization ratings of pharmacies. The pharmacy can be judged on a therapy class by therapy class basis with factors that reflect the demographic, socio-economic, location, benefits attributes, etc. that actually affect the performance of the pharmacy and may assist in determining the quality of care by a pharmacy.

    METHODS AND SYSTEMS FOR MAINTAINING PHARMACY PROVIDER NETWORKS

    公开(公告)号:US20190333158A1

    公开(公告)日:2019-10-31

    申请号:US16509721

    申请日:2019-07-12

    Abstract: Methods and systems for maintaining pharmacy provider networks are described. In one embodiment, claims adjudication data associated with a member and a prescribed drug is accessed. The prescribed drug associated with the member is classified as one of an acute medication and a maintenance medication. A pharmacy provider network is associated with the prescribed drug based on, at least in part, classifying the prescribed drug. It is determined if a pharmacy associated with the claims adjudication data is included within the pharmacy provider network associated with the prescribed drug. A pharmacy claim may be adjudicated for the prescribed drug based on the claim and the pharmacy provider network. Additional methods and systems are disclosed.

    Systems and methods for spill detection

    公开(公告)号:US10023341B1

    公开(公告)日:2018-07-17

    申请号:US14725418

    申请日:2015-05-29

    Abstract: A pharmaceutical filling system for a high volume pharmacy is described. The system can include a spill detection subsystem and method. The system can include a cameras to take images that a processed to determine presence of a spilled pharmaceutical. A mirror portion is provided so that the camera can take images of the entire field of the filling area. The mirror portion can be a concave mirror that increases the field of view of the camera. A light panel can illuminate the field of view to allow the camera to take high speed images. A controller can receive a series of at least two images captured by the camera and determine whether an object in the captured images is a spilled pharmaceutical.

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