Adapting workflows based on constrained optimizations

1. A method for optimizing the processing of database records, the method comprising:

maintaining, by a records management and processing system, a plurality of records in a database, each record of the plurality of records comprising a record of a healthcare service provided to a consumer by a healthcare service provider of a plurality of healthcare service providers and identifying at least one required action by at least one responsible entity of a plurality of responsible entities, wherein each responsible entity comprises a third-party payor for healthcare services and wherein the records management and processing system comprises an intermediary between systems of the plurality of service providers and systems of the plurality of responsible entities;

defining, by the records management and processing system, one or more rules, each rule comprising one or more conditions for processing one or more records of the plurality of records and at least one associated action to affect processing of the one or more records upon satisfaction of the one or more conditions of the rule;

applying, by the records management and processing system, one or more optimization functions, each optimization function comprising a function defining maximization of resource utilization in processing of the plurality of records based on one or more constraints related to data of the records, wherein the constraints comprise available resources for processing the plurality of records and a history of each record and wherein records of the identified set of records are identified based on an expected outcome of additional processing of the record;

identifying, by the records management and processing system, a set of records from the plurality of records based on applying the defined optimization functions and data of the records related to the constraints of the optimization function, wherein identifying the set of records comprises selecting the set of records from the plurality of records for further processing, and wherein the further processing is directed to satisfying, for each identified record, one or more responsibilities of one or more responsible entities; and

processing, by the records management and processing system, the identified records according to one or more workflows executed by the records management and processing system, wherein the one or more workflows perform the further processing for each identified record.

2. The method of claim 1 , wherein processing the identified set of records further comprises applying, by the records management and processing system, the defined one or more rules to the identified set of records and wherein the one or more workflows process the identified set of records based on actions defined in the applied one or more rules associated with conditions satisfied by the records of the identified set of records.

3. The method of claim 1 , wherein processing the identified records comprises generating a report identifying the set of records.

4. The method of claim 1 , wherein processing the identified records comprises generating an indication that a record of the plurality of records is one of the records of the identified set of records when the record is displayed in a user interface.

5. The method of claim 4 , wherein processing the identified records further comprises prioritizing processing of the plurality of records based on the identified set of records.

6. The method of claim 1 , wherein processing the identified records further comprises generating a visualization of the plurality of records indicating and indicating those records of the plurality of records that are members of the identified set of records.

7. The method of claim 1 , wherein the optimization function comprises a constrained linear optimization function.

8. The method of claim 1 , further comprising:

defining, by the records management and processing system, a model related to and defining processing conditions for the records; and

generating, by the records management and processing system, one or more predictions for each of the one or more records of the plurality of records, the one or more predictions comprising forecasts for further processing of the one or more records.

9. The method of claim 8 , wherein processing the identified records according to one or more workflows is further based on the generated one or more predictions.

10. A system comprising:

a processor; and

a memory coupled with and readable by the processor and storing therein a set of instructions which, when executed by the processor, causes the processor to manage and process database records by:

maintaining a plurality of records in a database, each record of the plurality of records comprising a record of a healthcare service provided to a consumer by a healthcare service provider of a plurality of healthcare service providers and identifying at least one required action by at least one responsible entity of a plurality of responsible entities, wherein each responsible entity comprises a third-party payor for healthcare services and wherein the records management and processing system comprises an intermediary between systems of the plurality of service providers and systems of the plurality of responsible entities;

defining one or more rules, each rule comprising one or more conditions for processing one or more records of the plurality of records and at least one associated action to affect processing of the one or more records upon satisfaction of the one or more conditions of the rule;

applying one or more optimization functions, each optimization function comprising a function defining maximization of resource utilization in processing of the plurality of records based on one or more constraints related to data of the records, wherein the constraints comprise available resources for processing the plurality of records and a history of each record and wherein records of the identified set of records are identified based on an expected outcome of additional processing of the record;

identifying a set of records from the plurality of records based on applying the defined optimization functions and data of the records related to the constraints of the optimization function, wherein identifying the set of records comprises selecting the set of records from the plurality of records for further processing, and wherein the further processing is directed to satisfying, for each identified record, one or more responsibilities of one or more responsible entities; and

processing the identified records according to one or more workflows executed by the records management and processing system, wherein the one or more workflows perform the further processing for each identified record.

11. The system of claim 10 , wherein processing the identified set of records further comprises applying the defined one or more rules to the identified set of records and wherein the one or more workflows process the identified set of records based on actions defined in the applied one or more rules associated with conditions satisfied by the records of the identified set of records.

12. The system of claim 10 , wherein processing the identified records comprises at least one of generating a report identifying the set of records, generating an indication that a record of the plurality of records is one of the records of the identified set of records when the record is displayed in a user interface, prioritizing processing of the plurality of records based on the identified set of records, or generating a visualization of the plurality of records indicating and indicating those records of the plurality of records that are members of the identified set of records.

13. The system of claim 10 , wherein the optimization function comprises a constrained linear optimization function.

14. A non-transitory, computer-readable medium comprising a set of instructions stored therein which, when executed by a processor, causes the processor to manage and process database records by:

maintaining a plurality of records in a database, each record of the plurality of records comprising a record of a healthcare service provided to a consumer by a healthcare service provider of a plurality of healthcare service providers and identifying at least one required action by at least one responsible entity of a plurality of responsible entities, wherein each responsible entity comprises a third-party payor for healthcare services and wherein the records management and processing system comprises an intermediary between systems of the plurality of service providers and systems of the plurality of responsible entities;

defining one or more rules, each rule comprising one or more conditions for processing one or more records of the plurality of records and at least one associated action to affect processing of the one or more records upon satisfaction of the one or more conditions of the rule;

applying one or more optimization functions, each optimization function comprising a function defining maximization of resource utilization in processing of the plurality of records based on one or more constraints related to data of the records, wherein the constraints comprise available resources for processing the plurality of records and a history of each record and wherein records of the identified set of records are identified based on an expected outcome of additional processing of the record;

identifying a set of records from the plurality of records based on applying the defined optimization functions and data of the records related to the constraints of the optimization function, wherein identifying the set of records comprises selecting the set of records from the plurality of records for further processing, and wherein the further processing is directed to satisfying, for each identified record, one or more responsibilities of one or more responsible entities; and

processing the identified records according to one or more workflows executed by the records management and processing system, wherein the one or more workflows perform the further processing for each identified record.

15. The non-transitory, computer-readable medium of claim 14 , wherein processing the identified set of records further comprises applying the defined one or more rules to the identified set of records and wherein the one or more workflows process the identified set of records based on actions defined in the applied one or more rules associated with conditions satisfied by the records of the identified set of records.

16. The non-transitory, computer-readable medium of claim 14 , wherein processing the identified records comprises at least one of generating a report identifying the set of records, generating an indication that a record of the plurality of records is one of the records of the identified set of records when the record is displayed in a user interface, prioritizing processing of the plurality of records based on the identified set of records, or generating a visualization of the plurality of records indicating and indicating those records of the plurality of records that are members of the identified set of records.

17. The non-transitory, computer-readable medium of claim 14 , wherein the optimization function comprises a constrained linear optimization function.