Granted Patent B2

US 12,633,421 · App. 19/345,911 · Granted May 19, 2026

Inventors: Bryan Wayne Johnson (Brookline, MA); Myrto M. Miltiadous (New York, NY); Christopher George Glazner (New York, NY); Vasile Iulian Ilies (Boston, MA); Eshaan Ghosh (Milton, CA); Jessica Chau (Richmond Hill, CA); Youzhi Wu (Summit, NJ)

Assignee: Veeva Systems Inc.

G16H50/70

Abstract

Claims (91)

1 . A method for generating an electronic file comprising:

receiving, by a provider computing system, a plurality of first data records from a covered entity computing system;

modifying, by the provider computing system, the plurality of first data records to generate a plurality of modified first data records;

receiving, by the provider computing system, a plurality of second data records from a national health repository;

selecting, by the provider computing system, a first digital projection model and a second digital projection model;

determining, by the provider computing system, a first set of digitally projected records using the first digital projection model based on at least one of: the plurality of modified first data records or the plurality of second data records;

determining, by the provider computing system, a second set of digitally projected records using the second digital projection model based on at least one of: the plurality of modified first data records or the plurality of second data records;

selecting, by the provider computing system, the first set of digitally projected records as a final set of digitally projected records;

storing, by the provider computing system, the selected first set of digitally projected records in a repository;

receiving, by the provider computing system, a request to lock the first digital projection model;

receiving, by the provider computing system, a plurality of new first data records from the covered entity computing system;

modifying, by the provider computing system, the plurality of new first data records to generate a plurality of modified new first data records;

receiving, by the provider computing system, a plurality of new second data records from a national health repository;

determining, by the provider computing system and based on the request to lock the first digital projection model, a third set of digitally projected records using the first digital projection model based on at least one of: the plurality of modified new first data records or the plurality of new second data records;

storing, by the provider computing system, the third set of digitally projected records in the repository;

receiving, by the provider computing system, a file generation request including a file destination address;

generating, by the provider computing system, the electronic file including at least one digitally projected record of the third set of digitally projected records,

providing, by the provider computing system, the electronic file to the file destination address of the file generation request.

2 . The method of claim 1 , wherein the file generation request further includes a query including a configuration property, and wherein the method further includes:

executing, by the provider computing system, the query on the repository to select at least one digitally projected record of the third set of digitally projected records based on the configuration property.

3 . The method of claim 2 , wherein the configuration property is at least one of: a timeframe, a data record type, a minimum value, and a maximum value.

4 . The method of claim 1 , wherein the covered entity computing system is a first covered entity computing system associated with a medical claims company, and wherein the plurality of first data records are a plurality of medical claim (Mx) data records, and wherein the method further comprises:

receiving, by the provider computing system, a plurality of prescription claim (Rx) data records from a second covered entity computing system associated with a pharmacy;

modifying, by the provider computing system, the plurality of Rx data records to generate a plurality of modified Rx data records,

wherein determining the first set of digitally projected records is based on at least one of: the plurality of modified Mx data records, the plurality of modified Rx data records, or the plurality of second data records, and wherein determining the second set of digitally projected records is based on at least one of: the plurality of modified Mx data records, the plurality of modified Rx data records, or the plurality of second data records.

5 . The method of claim 4 , wherein the plurality of new first data records are a plurality of new Mx data records, and wherein the method further comprises:

receiving, by the provider computing system, a plurality of new Rx data records from the second covered entity computing system;

modifying, by the provider computing system, the plurality of new Rx data records to generate a plurality of modified new Rx data records,

wherein determining the third set of digitally projected records is based on at least one of: the plurality of modified new Mx data records, the plurality of modified new Rx data records, or the plurality of new second data records.

6 . The method of claim 1 , wherein the first projection model is at least one of: a binary classification model, a neural network model, a multiclass classification model, or a regression model.

7 . The method of claim 1 , wherein the provider computing system determines the first set of digitally projected values and a first confidence score, wherein the provider computing system determines the second set of digitally projected values and a second confidence score, and wherein the provider computing system selects the first set of digitally projected records as a final set of digitally projected records based on the first confidence score and the second confidence score.

8 . A method for generating an electronic file comprising:

receiving, by a provider computing system, a plurality of first data records from a covered entity computing system;

modifying, by the provider computing system, the plurality of first data records to generate a plurality of modified first data records;

selecting, by the provider computing system, a first digital projection model and a second digital projection model;

training, by the provider computing system, the first digital projection model to generate a plurality of first model parameters;

determining, by the provider computing system, a first set of digitally projected records using the first digital projection model based on the plurality of modified first data records and the plurality of first model parameters;

training, by the provider computing system, the second digital projection model to generate a plurality of second model parameters;

determining, by the provider computing system, a second set of digitally projected records using the second digital projection model based on the plurality of modified first data records and the plurality of second model parameters;

selecting, by the provider computing system, the first set of digitally projected records as a final set of digitally projected records;

storing, by the provider computing system, the selected first set of digitally projected records in a first repository;

storing, by the provider computing system, the plurality of first model parameters in a second repository;

receiving, by the provider computing system, a plurality of new first data records from the covered entity computing system;

modifying, by the provider computing system, the plurality of new first data records to generate a plurality of modified new first data records;

selecting, by the provider computing system, the plurality of first model parameters from the second repository;

determining, by the provider computing system, a third set of digitally projected records using the first digital projection model based on the plurality of modified new first data records and the plurality of first model parameters;

storing, by the provider computing system, the third set of digitally projected records in the first repository;

receiving, by the provider computing system, a file generation request including a file destination address;

generating, by the provider computing system, the electronic file including at least one digitally projected record of the third set of digitally projected records;

providing, by the provider computing system, the electronic file to the file destination address of the file generation request.

9 . The method of claim 8 , wherein the file generation request further includes a query including a configuration property, and wherein the method further includes:

executing, by the provider computing system, the query on the first repository to select at least one digitally projected record of the third set of digitally projected records based on the configuration property.

10 . The method of claim 9 , wherein the configuration property is at least one of: a timeframe, a data record type, a minimum value, and a maximum value.

11 . The method of claim 8 , wherein the covered entity computing system is a first covered entity computing system associated with a medical claims company, and wherein the plurality of first data records are a plurality of medical claim (Mx) data records, and wherein the method further comprises:

receiving, by the provider computing system, a plurality of prescription claim (Rx) data records from a second covered entity computing system associated with a pharmacy;

modifying, by the provider computing system, the plurality of Rx data records to generate a plurality of modified Rx data records,

wherein determining the first set of digitally projected records is based on the plurality of first model parameters and at least one of: the plurality of modified Rx data records or the plurality of modified Mx data records, and wherein determining the second set of digitally projected records is based on the plurality of second model parameters and at least one of: the plurality of modified Rx data records or the plurality of modified Mx data records.

12 . The method of claim 11 , wherein the plurality of new first data records are a plurality of new Mx data records, and wherein the method further comprises:

receiving, by the provider computing system, a plurality of new Rx data records from the second covered entity computing system;

modifying, by the provider computing system, the plurality of new Rx data records to generate a plurality of modified new Rx data records,

wherein determining the third set of digitally projected records is based on the plurality of first model parameters and at least one of: the plurality of modified new Mx data records or plurality of modified new Rx data records.

13 . The method of claim 8 , wherein the first projection model is at least one of: a binary classification model, a neural network model, a multiclass classification model, or a regression model.

14 . The method of claim 8 , wherein the provider computing system determines the first set of digitally projected values and a first confidence score, wherein the provider computing system determines the second set of digitally projected values and a second confidence score, and wherein the provider computing system selects the first set of digitally projected records as a final set of digitally projected records based on the first confidence score and the second confidence score.

15 . The method of claim 8 , wherein the first set of digitally projected records and the second set of digitally projected records are projected for a first timeframe, and wherein the third set of digitally projected records are projected for a second timeframe, and wherein the second timeframe is shorter than the first timeframe.

16 . The method of claim 8 , wherein the first timeframe is a month, and wherein the second timeframe is at least one of a: a week or a day.

17 . A method for generating an electronic file comprising:

receiving, by a provider computing system, a plurality of first data records from a covered entity computing system;

modifying, by the provider computing system, the plurality of first data records to generate a plurality of modified first data records;

selecting, by the provider computing system, a first digital projection model and a second digital projection model;

determining, by the provider computing system, a first set of digitally projected records using the first digital projection model based on the plurality of modified first data records;

determining, by the provider computing system, a second set of digitally projected records using the second digital projection model based on the plurality of modified first data records;

selecting, by the provider computing system, the first set of digitally projected records as a final set of digitally projected records;

storing, by the provider computing system, the selected first set of digitally projected records in a repository;

receiving, by the provider computing system, a request to lock the first digital projection model;

receiving, by the provider computing system, a plurality of new first data records from the covered entity computing system;

modifying, by the provider computing system, the plurality of new first data records to generate a plurality of modified new first data records;

determining, by the provider computing system and based on the request to lock the first digital projection model, a third set of digitally projected records using the first digital projection model based on at least one of: the plurality of modified new first data records or the plurality of first data records;

storing, by the provider computing system, the third set of digitally projected records in the repository;

receiving, by the provider computing system, a file generation request including a query and a file destination address,

wherein the query includes a configuration property;

executing, by the provider computing system, the query on the repository to select at least one digitally projected record of the third set of digitally projected records based on the configuration property;

generating, by the provider computing system, the electronic file including the at least one digitally projected record of the third set of digitally projected records, providing, by the provider computing system, the electronic file to the file destination address of the file generation request.

18 . The method of claim 17 , wherein the covered entity computing system is a first covered entity computing system associated with a medical claims company, and wherein the plurality of first data records are a plurality of medical claim (Mx) data records, and wherein the method further comprises:

receiving, by the provider computing system, a plurality of prescription claim (Rx) data records from a second covered entity computing system associated with a pharmacy;

modifying, by the provider computing system, the plurality of Rx data records to generate a plurality of modified Rx data records,

wherein determining the first set of digitally projected records is based on at least one of: the plurality of modified Mx data records or the plurality of modified Rx data records, and wherein determining the second set of digitally projected records is based on at least one of: the plurality of modified Mx data records or the plurality of modified Rx data records.

19 . The method of claim 18 , wherein the plurality of new first data records are a plurality of new Mx data records, and wherein the method further comprises:

receiving, by the provider computing system, a plurality of new Rx data records from the second covered entity computing system;

modifying, by the provider computing system, the plurality of new Rx data records to generate a plurality of modified new Rx data records,

wherein determining the third set of digitally projected records is based on at least one of: the plurality of modified new Mx data records, the plurality of modified new Rx data records, the plurality of modified Mx data records, or the plurality of modified Rx data records.

20 . The method of claim 17 , wherein the first projection model is at least one of: a binary classification model, a neural network model, a multiclass classification model, or a regression model.

Assignments (1)

Continuity (2)

References Cited (95)