Generative AI-Based System and Method for Claim Data Processing and Evaluation
Summary
USPTO published patent application US20260099883A1 for a generative AI system that processes and evaluates insurance claims using large language models. The system generates prompt data from parsed standard operating procedures and rules, then validates non-adjudicated claims against generated rules to produce recommendations for claim resolution.
What changed
USPTO published patent application US20260099883A1 disclosing a generative AI-based system for insurance claim data processing and evaluation. The invention describes using large language models to process standard operating procedure data and rules to generate first and second sets of rules for validating claims. Non-adjudicated claims data is extracted along with non-automated edit codes, validated against the generated rules, and recommendations are produced for resolving claims.
Insurers and technology companies developing AI-based claims processing systems should monitor this application for potential licensing opportunities or to assess competitive IP landscape. The patent's broad claims covering LLM-based claim evaluation could affect future product development strategies in the insurance technology sector.
What to do next
- Monitor for patent issuance
- Track AI claims processing technology developments
- Review IP portfolio for overlap with disclosed methods
Archived snapshot
Apr 11, 2026GovPing captured this document from the original source. If the source has since changed or been removed, this is the text as it existed at that time.
GENERATIVE AI-BASED SYSTEM AND METHOD FOR CLAIM DATA PROCESSING AND EVALUATION
Application US20260099883A1 Kind: A1 Apr 09, 2026
Inventors
Debojyoti Hazra, Latoya James, Mohamed Abdul Sattar, Guruprasad Krishnadoss, Jigar Ashok Parikh, Chandra Sekhar Dasika, Muniraju Bhadrappa, Milind Tilak, Richa Chaudhary
Abstract
A system and method for Gen AI based claim data processing and evaluation is provided. The present invention enables generating prompt data by processing parsed standard operation procedure data and rules data associated with a first set of pre-defined rules. The prompt data is provided as a first prompt data to a Large Language Model (LLM) to generate a set of first rules. Set of first rules is provided along with output generation instructions as a second prompt data to the LLM to generate a set of second rules. Non-adjudicated claims data is extracted along with corresponding non-automated edit codes for evaluation. An output is generated in the form of recommendations by validating non-adjudicated claims data and corresponding non-automated edit codes based on a comparison with set of second rules. The recommendations are provided for resolving the non-adjudicated claims data.
CPC Classifications
G06Q 40/08 G06F 40/205 G06N 3/042 G06N 3/0475 G06N 3/10 G06F 40/103
Filing Date
2025-04-09
Application No.
19174284
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