AdjudiPro{reg_sign} 2.0
- United HealthCare Corp., Minnetonka, MN (United States)
- United HealthCare Corp., Edina, MN (United States)
AdjudiPro, version 2.0, is the latest incarnation of United HealthCare`s patented physician claims adjudication expert system (US patent No. 5,359,509). Its core is an embedded expert system that contains the logic for processing 55% of all physician claim situations reviewed on United HealthCare`s managed care system. Certain physician services are reviewed as part of the claims adjudication process to ensure that submitted charges meet contractual, and other guidelines. In 1995, nearly $20 million in gross savings was realized through use of this system. Since its initial deployment in 1991-1992, there has been a steep increase in AdjudiPro`s processing volume. This increased demand created a number of issues that had to be addressed to ensure AdjudiPro`s continued viability and growth. As a result, much of the past three years was spent rearchitecting AdjudiPro to meet the increasing load placed on it, while achieving acceptable throughput. AdjudiPro is now an essentially real-time application, processing claims twenty-four hours a day, seven days a week. This paper describes the current AdjudiPro application, and the key issues faced during the past three years.
- OSTI ID:
- 430910
- Report Number(s):
- CONF-960876-; TRN: 96:006521-0287
- Resource Relation:
- Conference: 13. National conference on artifical intelligence and the 8. Innovative applications of artificial intelligence conference, Portland, OR (United States), 4-8 Aug 1996; Other Information: PBD: 1996; Related Information: Is Part Of Proceedings of the thirteenth national conference on artificial intelligence and the eighth innovative applications of artificial intelligence conference. Volume 1 and 2; PB: 1626 p.
- Country of Publication:
- United States
- Language:
- English
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