IntegerHealth Patents AI Engine to Predict High-Cost Medical Claims in Real-Time

AI Platform Flags High-Cost Health & Workers’ Compensation Cases at First Report of Illness or Injury

FORT WORTH, TX, UNITED STATES, August 28, 2025 /EINPresswire.com/ -- The U.S. Patent and Trademark Office granted IntegerHealth Technologies Patent No. 12,400,188 for its “High-Cost Medical Claim Prediction & Navigation Engine,” a breakthrough that flags costly cases before they spiral out of control.

The engine uses artificial intelligence (AI) -- specifically machine learning (ML) and natural language processing (NLP) -- to identify potential high-cost health plan and workers’ compensation cases as soon as the illness or injury occurs.

Conventional analytics take 30-60 days to analyze medical claims data, much too long. If a case is going to be a high-cost outlier, it has already careened out of control by then. IntegerHealth’s engine instead analyzes the electronic health records (EHRs) under a health plan and the adjuster notes under a workers’ compensation program to identify potential outliers based on the initial entries in those records -- which are made almost as soon as the illness or injury occurs.

The engine integrates with the EHR and adjuster note systems, and sends a red flag back to them if the case appears problematic before the provider or adjuster even finish their entry -- while there is still time to do something about it.

IntegerHealth is a pioneer in quantifying healthcare outcomes, translating complex data into a single, easy-to-understand dollar value. By doing so, IntegerHealth gives insurers, providers and employers a precise way to evaluate healthcare efficiency -- and a competitive edge in network and plan design, contract negotiations and care management.

“This patent propels our groundbreaking work quantifying outcomes into the future,” said Dr. Jack McCallum, CEO of IntegerHealth. “Our past patents quantified outcomes after the fact, this one predicts them so you can intervene before costs explode.”

IntegerHealth will partner with selected health systems and workers’ compensation insurance carriers and third-party administrators (TPAs) to develop this new product. We invite interested parties to contact us to explore pilot opportunities.

A Proven Leader in Healthcare Analytics Innovation

This patent is IntegerHealth’s fifth, and its fourth in the last nine months. IntegerHealth’s other patents:

1. Claims + Absence Costs Solution -- Quantifies outcomes by combining medical and pharmacy claims costs with the productivity costs of illnesses and injuries.

2. Claims per Healthy Day Solution -- Quantifies the medical and pharmacy claims cost per day to keep a person healthy.

3. Wellness Program ROI Calculator -- Calculates the true financial return on wellness programs, including the impact of GLP-1 weight loss drugs.

4. Tree Frog Navigation System -- Guides users through complex data in an intuitive and visual way.

To Learn More

• Read the nationally published article “Predicting Your Next Big Workers’ Compensation Claim.”
• Watch the two-minute silent YouTube video, the “IntegerHealth Difference.”
• Visit the IntegerHealth website at www.integerhealth.com.

About IntegerHealth

IntegerHealth Technologies is a healthcare analytics company that quantifies healthcare outcomes for insurers, health systems and employers -- something that no one else does. Our patented solutions merge cost and quality into a single objective dollar value on each outcome, generating actionable analytics that drive down healthcare costs while improving the quality of care for health plans, wellness programs and workers’ compensation.

Scott Roloff
IntegerHealth Technologies
+1 817-849-9402
sroloff@integerhealth.com

IntegerHealth Difference

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