According to GlobalData’s company profile on UnitedHealth Group, Content recommendation models was a key innovation area identified from patents. UnitedHealth Group's grant share as of September 2023 was 40%. Grant share is based on the ratio of number of grants to total number of patents.

Method for determining payment recommendations based on healthcare service quantities and time spans

A recently filed patent (Publication Number: US20230316406A1) describes a method for managing and recommending payments for healthcare services provided to patients. The method involves receiving a claim line that identifies the time span and quantity of a healthcare service provided to a patient. The system then determines if the quantity of service exceeds a maximum amount for a predefined time period. If it does, and if the time span also exceeds the predefined time period, the system extends the predefined time period. A payment recommendation is generated based on whether the quantity of service exceeds the maximum amount for the predefined time period and/or the extended predefined time period. The payment recommendation can be communicated to the sender of the claim line, who may be a payor or provider of the healthcare service.

The method also includes receiving a second claim line that identifies a second time span and quantity of healthcare service provided to the patient. The system determines if the beginning date of the second time span is within the predefined time period and extends the predefined time period if necessary. A payment recommendation for the second claim line is generated based on whether the combined quantity of service provided in the first and second claim lines exceeds the maximum amount for the extended predefined time period. This payment recommendation can also be communicated to the sender of the second claim line.

In some cases, a third claim line may be generated if the combined quantity of service provided in the first and second claim lines exceeds the maximum amount for the extended predefined time period. The third claim line contains a quantity of service that is less than the second claim line. A recommendation not to pay the second claim line for the excess quantity and a recommendation to pay the third claim line are generated. These payment recommendations can be communicated to the sender of the first and second claim lines.

The patent also describes a system comprising a processor and memory with computer-readable program code to perform the operations described above. Additionally, a computer program product is mentioned, which includes a non-transitory computer-readable storage medium with executable program code to perform the same operations as the system.

Overall, this patent presents a method and system for managing and recommending payments for healthcare services based on predefined time periods and maximum service quantities. It aims to streamline the payment process and ensure that healthcare providers and payors adhere to the predefined limits.

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