/Systems And Methods For Using Trained Predictive Modeling To Reduce Misdiagnoses Of Critical Illnesses
Abstract

A trained predictive server is provided for determining that a diagnosis and treatment plan is inaccurate. The trained predictive server includes a processor configured to receive a set of prior authorization (PA) data associated with a medical claim for a patient, and determine that the PA data indicates that the medical claim is associated with a qualifying critical illness and control use of medical devices. The processor can extract component data from the set of PA data, and apply the extracted component data to a predictive model associated with the qualifying critical illness to determine whether the medical claim is associated with an inaccurate diagnosis and treatment plan. Upon determining that the medical claim is associated with an inaccurate diagnosis and treatment plan, the processor can generate a request for review of the diagnosis and treatment plan using the set of PA data and stop use of a medical device.

Full Text

What is claimed is:

A trained predictive server is provided for determining that a diagnosis and treatment plan is inaccurate. The trained predictive server includes a processor configured to receive a set of prior authorization (PA) data associated with a medical claim for a patient, and determine that the PA data indicates that the medical claim is associated with a qualifying critical illness and control use of medical devices. The processor can extract component data from the set of PA data, and apply the extracted component data to a predictive model associated with the qualifying critical illness to determine whether the medical claim is associated with an inaccurate diagnosis and treatment plan. Upon determining that the medical claim is associated with an inaccurate diagnosis and treatment plan, the processor can generate a request for review of the diagnosis and treatment plan using the set of PA data and stop use of a medical device.
Timeline
Filed
04/20/2026
Published
08/27/2026
Granted
Not Available
IPC Codes(6)
G06Q 40/08:Insurance
G16H 10/60:for patient-specific data, e.g. for electronic patient records
G16H 20/13:delivered from dispensers