Machine structured plan description

• US 10,552,915 B1
• Filed: 08/21/2018
• Issued: 02/04/2020
• Est. Priority Date: 08/21/2018
• Status: Active Grant

• Current Assignee: Collective Health, Inc.
• Original Assignee: Collective Health, Inc.
• Inventors: Khalak, Asif, Martinez-Ortuno, Sergio, Chiv, Henning, Gard, Michelle Alicia, Wise, Emma Louise
• Primary Examiner(s): Khattar, Rajesh
• Application Number:
  US16/107,262
• Time in Patent Office: 532 Days
• CPC Class Codes: G06Q 10/1057 Benefits or employee welfare, e.g. insurance, holiday or retirement packages
• CPC Class Codes: G06Q 40/08 Insurance

Abstract

A plan authoring tool can receive user input describing parameters of benefits of a benefit plan. The plan authoring tool can convert the user input into a machine structured plan description (MSPD) that defines the benefit plan. The MSPD can be used by a plan documentation generator to generate one or more plan documents that explain the benefits and/or indicate how to manually adjudicate claims submitted in association with the benefit plan. The MSPD can also be used to automatically adjudicate claims. Plan analysis tools can be used to evaluate an MSPD to validate a new or edited benefit plan and/or provide user feedback on the benefit plan so that users, if desired, can revise the MSPD via the plan authoring tool.

Claims

1. A computer-implemented method comprising:

receiving user input at a plan authoring tool, the user input describing one or more parameters of one or more benefits of a benefit plan;

translating, by the plan authoring tool, the user input into a machine structured plan description (MSPD) that defines the benefit plan, including representing the one or more benefits as plan objects of the MSPD using a domain-specific language;

loading the MSPD and a plurality of templates into a plan documentation generator, individual ones of the plurality of templates corresponding to at least one of different document types or different document formats; and

automatically generating, by the plan documentation generator, a plurality of plan documents associated with the benefit plan by converting information expressed in the domain specific language in one or more of the plan objects of the MSPD into natural language according to the plurality of templates, wherein individual ones of the plurality of plan documents describe information about the benefit plan consistently with other ones of the plurality of plan documents based on the MSPD,

wherein the plan authoring tool and the plan documentation generator execute via computer-executable instructions on one or more computing devices.

2. The computer-implemented method of claim 1, wherein the plurality of templates is configured such that a plan document of the plurality of plan documents is generated as content that explains the one or more benefits to a plan participant of the benefit plan or a potential plan participant.

3. The computer-implemented method of claim 2, wherein the content is electronic content for a website for the plan participant or the potential plan participant.

4. The computer-implemented method of claim 2, wherein the content is generated in a printable form for printing and physical distribution to the plan participant or the potential plan participant.

5. The computer-implemented method of claim 1, wherein the plurality of templates is configured such that a plan document of the plurality of plan documents is generated as a set of claims adjudication rules that instruct a claims administrator how to manually adjudicate a submitted claim according to the benefit plan defined by the MSPD.

6. The computer-implemented method of claim 1, further comprising generating feedback regarding the benefit plan defined by the MSPD prior to generating the plurality of plan documents.

7. The computer-implemented method of claim 6, wherein the feedback is based on determining whether the MSPD meets one or more validation conditions.

8. The computer-implemented method of claim 6, wherein the feedback is based on outcomes of simulations that automatically adjudicate simulated claims according to the MSPD.

9. The computer-implemented method of claim 8, wherein the simulated claims are generated at least in part on real claims that have been previously adjudicated.

10. The computer-implemented method of claim 6, further comprising displaying the feedback to a user of the plan authoring tool, receiving additional user input at the plan authoring tool in response to the feedback, and editing the MSPD according to the additional user input.

11. The computer-implemented method of claim 6, further comprising automatically editing the MSPD at the plan authoring tool according to the feedback.

12. The computer-implemented method of claim 6, wherein the feedback includes recommendations for editing the MSPD that are generated based at least in part on machine learning.

13. A plan administration system comprising:

one or more computing devices configured to execute, via computer-executable instructions, a plan authoring tool and a plan documentation generator,

wherein the plan authoring tool accepts user input describing one or more parameters of one or more benefits of a benefit plan and translates the user input into a machine structured plan description (MSPD) that defines the benefit plan, including representing the one or more benefits as plan objects of the MSPD using a domain specific language, and

wherein the plan documentation generator uses a plurality of templates corresponding to at least one of different document types or different document formats to automatically generate a plurality of plan documents associated with the benefit plan by converting information expressed in the domain-specific language in one or more of the plan objects of the MSPD into natural language according to the plurality of templates, wherein the plurality of plan documents consistently describes information about the benefit plan based on the MSPD.

14. The plan administration system of claim 13, wherein the plurality of templates is configured such that a plan document of the plurality of plan documents is generated as content that explains the one or more benefits to a plan participant of the benefit plan or a potential plan participant.

15. The plan administration system of claim 13, wherein the plurality of templates is configured such that a plan document of the plurality of plan documents is generated as a set of claims adjudication rules that instruct a claims administrator how to manually adjudicate a submitted claim according to the benefit plan defined by the MSPD.

16. The plan administration system of claim 13, further comprising one or more plan analysis tools configured to generate feedback regarding the benefit plan defined by the MSPD prior to generating the plurality of plan documents based on at least one of 1) whether the MSPD meets one or more validation condition, and 2) outcomes of simulations that automatically adjudicate simulated claims according to the MSPD.

17. One or more non-transitory computer-readable media storing computer-executable instructions that, when executed by one or more processors, cause the one or more processors to perform operations comprising:

receiving user input describing one or more parameters of one or more benefits of a benefit plan;

translating the user input into a machine structured plan description (MSPD) that defines the benefit plan, including representing the one or more benefits as plan objects of the MSPD using a domain-specific language;

loading a plurality of templates, individual ones of the plurality of templates corresponding to at least one of different document types or different document formats; and

automatically generating a plurality of plan documents associated with the benefit plan by converting information in one or more of the plan objects of the MSPD into natural language according to the plurality of templates, wherein the plurality of plan documents consistently describes information about the benefit plan based on the MSPD.

18. The non-transitory computer-readable media of claim 17, wherein the operations further comprise generating feedback regarding the benefit plan defined by the MSPD prior to generating the plurality of plan documents.

19. The non-transitory computer-readable media of claim 18, wherein the feedback is based on determining whether the MSPD meets one or more validation conditions.

20. The non-transitory computer-readable media of claim 18, wherein the feedback is based on outcomes of simulations that automatically adjudicate simulated claims according to the MSPD.