US Patent 11586955 Ontology and rule based adjudication

In an example, an ontology analyzer may generate an ontology, based on a claim adjudication request. The claim adjudication request may be processed, based on the ontology to provide an ontology based inference. A rule based analyzer may identify a predefined rule corresponding to the claim adjudication request and process the request, based on the predefined rule. A conflict resolver may resolve a conflict which may occur between the ontology based inference and the rule based inference. When a conflict is detected, a predefined criteria may be selected for resolving the conflict, the predefined criteria comprising rules to select one of the ontology based inference and the rule based inference to maximize a probability of accurately processing the claim adjudication request in case of a conflict.