Configuring a semantic network to process health care transactions

• US 20050033605A1
• Filed: 10/07/2003
• Published: 02/10/2005
• Est. Priority Date: 07/27/2000
• Status: Abandoned Application

• Current Assignee: HealthEdge, Inc.
• Original Assignee: HealthEdge, Inc.
• Inventors: Peled, Alon, Morris, John, Easton, Chris, Kennedy, Andrew, Kennedy, James, Trustman, John, Krylov, Eugene, Vujisic, Lyubomir, Yoshida, Andre, Bergeron, Heather Ellen, Koen, Doug, Pringle, Simone Lemos, Pai, Jayant
• Application Number:
  US10/680,863
• Publication Number:
  US 20050033605A1
• Time in Patent Office: Days
• US Class Current: 705/2
• CPC Class Codes: G06F 40/30 Semantic analysis
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 30/0601 Electronic shopping [e-shopping]
• CPC Class Codes: G16H 40/20 for the management or administration of healthcare resources or facilities, e.g. managing hospital staff or surgery rooms

Abstract

The disclosed technology can identify indicia associated with different entity types (e.g., health care companies, health care suppliers, health care practitioners, etc.) that interact within a health care industry, identify one or more relationships (e.g., contractual provisions) that can affect interactions between such entity types, and identify transactions associated with one or more of the interactions. Further, the identified transactions can be organized into one or more transaction sequences. The identified indicia, the one or more identified relationships, and the one or more transaction sequences can then be associated to form a semantic network. An instance of the semantic network can be formed based, at least in part, on a detection of at least one interaction associated with the entities.

Claims

1. A method, comprising:

identifying indicia associated with a health care company;

identifying indicia associated with at least one health care supplier;

identifying at least one relationship affecting interactions between the health care company and the at least one health care supplier;

identifying a plurality of transactions associated with at least one of the interactions;

organizing the plurality of transactions into at least one transaction sequence; and

associating the identified indicia of the health care company and the at least one health care supplier, the at least one identified relationship, and the at least one transaction sequence to form a semantic network, wherein an instance of the semantic network is formable based, at least in part, on a detection of the at least one interaction.

2. The method of claim 1, further comprising:

storing the identified indicia of the health care company and the at least one health care supplier in at least one data structure; and

assigning at least one date-time indicia to the data structure.

3. The method of claim 1, further comprising:

receiving the identified indicia of the health care company and the at least one health care supplier from an electronic data interchange system.

4. The method of claim 1, further comprising:

receiving the identified indicia of the health care company and the at least one health care supplier from at least one of an application program interface, a user interface, and a software editing tool.

5. The method of claim 1, further comprising:

representing at least some of the identified indicia of the health care company and the at least one health care supplier in a natural language format exhibiting a fixed context and a fixed grammar.

6. The method of claim 5, wherein the fixed grammar exhibits a Backus-Naur format.

7. The method of claim 5, wherein the fixed context is based, at least in part, on an industry-specific data structure, the industry-specific data structure being used to identify operations associated with the plurality of transactions.

8. The method of claim 5, further comprising:

parsing the natural language representation of the identified indicia into a plurality of fields; and

mapping at least some of the fields into at least one data structure.

9. The method of claim 8, further comprising:

assigning at least one date-time indicia to the at least one data structure.

10. The method of claim 1, wherein the at least one relationship corresponds to at least one contractual provision associated with the health care company and the at least one health care supplier.

11. The method of claim 10, further comprising:

representing the at least one contractual provision in a natural language format exhibiting a fixed context and a fixed grammar,

wherein the fixed grammar exhibits a Backus-Naur format, and

wherein the fixed context is based, at least in part on an industry-specific data structure, the industry-specific data structure being used to identify operations associated with the plurality of transactions.

12. The method of claim 1, wherein the at least one interaction is associated with a request for payment of services performed.

13. The method of claim 1, further comprising:

forming an electronic message in response to detecting an error associated with the identified indicia.

14. The method of claim 1, wherein the identified indicia correspond to a plurality of nodes in the semantic network and the at least one identified relationship corresponds to links interconnecting at least some of the plurality of nodes in the semantic network.

15. The method of claim 1, wherein the instance of the semantic network includes:

at least one node based on the health care company; and

at least one node based on the at least one health care supplier.

16. The method of claim 15, wherein the instance of the semantic network includes:

at least one node based on a benefit plan;

at least one node based on a health care plan contract;

at least one node based on a health subscription; and

at least one node based on a health care practitioner.

17. The method of claim 1, further comprising:

querying data strictures associated with the semantic network; and

forming an electronic document containing at least some of the identified indicia and data associated with the at least one identified relationship in response to the query of the data structures, wherein the electronic document is viewable in a natural language format exhibiting a fixed context and a fixed grammar.

18. A method, comprising:

identifying indicia associated with a health care company;

identifying indicia associated with at least one health care practitioner;

identifying at least one relationship affecting interactions between the health care company and the at least one health care practitioner;

identifying a plurality of transactions associated with at least one of the interactions;

organizing the plurality of transactions into at least one transaction sequence; and

associating the identified indicia of the health care company and the at least one health care practitioner, the at least one identified relationship, and the at least one transaction sequence to form a semantic network, wherein an instance of the semantic network is formable based, at least in part, on a detection of the at least one interaction.

19. The method of claim 18, further comprising:

storing the identified indicia of the health care company and the at least one health care practitioner in at least one data structure; and

assigning at least one date-time indicia to the data structure.

20. The method of claim 18, further comprising:

representing at least some of the identified indicia of the health care company and the at least one health care practitioner in a natural language format exhibiting a fixed context and a fixed grammar.

21. The method of claim 20, wherein the fixed grammar exhibits a Backus-Naur format.

22. The method of claim 20, wherein the fixed context is based, at least in part, on an industry-specific data structure, the industry-specific data structure being used to identify operations associated with the plurality of transactions.

23. The method of claim 20, further comprising:

parsing the natural language representation of the identified indicia into a plurality of fields; and

mapping at least some of the fields into at least one data structure.

24. The method of claim 23, further comprising:

assigning at least one date-time indicia to the at least one data structure.

25. The method of claim 18, wherein the at least one relationship corresponds to at least one contractual provision associated with the health care company and the at least one health care practitioner.

26. The method of claim 25, further comprising:

representing the at least one contractual provision in a natural language format exhibiting a fixed context and a fixed grammar,

wherein the fixed grammar exhibits a Backus-Naur format, and

wherein the fixed context is based, at least in part on an industry-specific data structure, the industry-specific data structure being used to identify operations associated with the plurality of transactions.

27. The method of claim 18, wherein the at least one interaction is associated with a request for payment of services performed.

28. The method of claim 18, wherein the identified indicia correspond to a plurality of nodes in the semantic network and the at least one identified relationship corresponds to links interconnecting at least some of the plurality of nodes in the semantic network.

29. The method of claim 18, further comprising:

querying data structures associated with the semantic network; and

forming an electronic document containing at least some of the identified indicia and data associated with the at least one identified relationship in response to the query of the data structures, wherein the electronic document is viewable in a natural language format exhibiting a fixed context and a fixed grammar.