System and method for using a first electronic representation of contract terms for generating a second electronic representation of the contract terms

• US 20060085311A1
• Filed: 10/14/2004
• Published: 04/20/2006
• Est. Priority Date: 10/14/2004
• Status: Active Grant

• Current Assignee: Cognizant Trizetto Software Group Incorporated (Cognizant Technology Solutions Corp.)
• Original Assignee: Trizetto Group Incorporated (Cognizant Technology Solutions Corp.)
• Inventors: Hoerle, Dale E., Hensley, Jeffery K.
• Granted Patent: US 8,768,729 B2
• Time in Patent Office: Days
• US Class Current: 705/35
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 40/00 Finance; Insurance; Tax strategies; Processing of corporate or income taxes
• CPC Class Codes: G06Q 40/08 Insurance

Abstract

Systems and methods are provided in which contract terms from a first electronic representation of a contract are used to form at least a part of a second electronic representation of the contract. For instance, the first electronic representation of a contract may be formed for use with a first software application, such as an adjudication application, and such first electronic representation of the contract is used by a system to form at least part of a second electronic representation of the contract, wherein such second electronic representation is used by a second software application, such as a contract management application. Disparate applications often utilize different representations of contract terms, and certain embodiments enable a second electronic representation to be formed by the system at least in part from a first electronic representation so that the different electronic representations are consistent as to the overlapping contract terms included therein.

Claims

1. A method comprising:

creating a first electronic representation of contract terms on a system, wherein said first electronic representation of the contract terms has a first format that is compatible with at least a first application; and

using, by said system, the first electronic representation of contract terms to generate at least a portion of a second electronic representation of the contract, wherein said second electronic representation of the contract has a second format that is compatible with at least a second application.

2. The method of claim 1 wherein said at least a first application includes an adjudication application.

3. The method of claim 1 wherein said at least a second application includes a contract management application.

4. The method of claim 1 wherein said at least a first application includes an adjudication application, and wherein said at least a second application includes a contract management application.

5. The method of claim 1 wherein said contract is a contract between an insurer and a service provider.

6. The method of claim 1 wherein said at least a portion includes financial terms of the contract.

7. The method of claim 1 wherein said at least a portion includes service discount terms of the contract.

8. The method of claim 1 wherein said creating the first electronic representation comprises:

associating at least one qualifier and a corresponding calculation method with at least one term of said contract.

9. The method of claim 1 wherein said first electronic representation associates at least one qualifier and a corresponding calculation method with each payment term of the contract.

10. The method of claim 9 wherein said each payment term governs payment from one party to the contract to another party to the contract.

11. The method of claim 9 wherein the at least one qualifier identifies at least one condition to be satisfied by a claim for payment in order to trigger the corresponding calculation method to be used in calculating an amount of payment.

12. The method of claim 1 wherein said second electronic representation includes a phrase describing a term of the contract.

13. The method of claim 12 wherein said phrase includes at least one sentence.

14. A method comprising:

electronically representing terms of a contract in a first software application stored to computer-readable medium; and

importing the terms of the contract from the first software application to a contract management application stored to computer-readable medium.

15. The method of claim 14 wherein said first software application is an adjudication application.

16. The method of claim 15 wherein said first software application is a claim adjudication application.

17. The method of claim 16 wherein said terms of said contract include terms governing payment by an insurer for claims submitted by a service provider, and wherein said claim adjudication application processes a submitted claim to determine an amount of payment by said insurer according to said terms of said contract.

18. The method of claim 14 wherein said terms of said contract include terms governing payment by an insurer for claims submitted by a service provider.

19. The method of claim 14 wherein said first software application is a contract modeler application operable to determine an impact of said terms on at least one party to said contract based on performance data.

20. The method of claim 14 wherein said electronically representing comprises electronically representing said terms of the contract in a format that is not compatible with said contract management application.

21. The method of claim 20 wherein said importing comprises translating the electronically represented terms of the contract into a format that is compatible with said contract management application.

22. A system comprising:

an adjudication application stored to computer-readable medium;

a contract management application stored to computer-readable medium;

a first electronic representation of contract terms stored to computer-readable medium, wherein said first electronic representation of said contract terms is compatible for use by said adjudication application; and

at least one adapter for transforming the first electronic representation of said contract terms to a second electronic representation of the contract terms, wherein said second electronic representation of said contract terms is compatible for use by said contract management application.

23. The system of claim 22 wherein said contract is between an insurer and a service provider.

24. The system of claim 23 wherein said adjudication application comprises a claim adjudication application for processing claims submitted to the insurer from the service provider to determine a payment amount for said claims in accordance with the contract.

25. The system of claim 22 wherein said first electronic representation is not compatible with said contract management application.

26. The system of claim 22 wherein said first electronic representation associates at least one qualifier and a corresponding calculation method with each payment term of the contract.

27. The system of claim 26 wherein the at least one qualifier identifies at least one condition to be satisfied by a claim for payment in order to trigger the corresponding calculation method to be used in calculating an amount of payment.

28. The system of claim 22 wherein said at least one adapter comprises:

an interface for receiving said first electronic representation;

logic for translating said first electronic representation into said second electronic representation; and

an interface for outputting said second electronic representation.

29. The system of claim 22 wherein said at least one adapter comprises:

a first adapter for receiving said first electronic representation, translating said first representation into an inter-adapter representation of the contract terms, and communicating said inter-adapter representation of the contract terms to a second adapter; and

the second adapter for receiving said inter-adapter representation of the contract terms, and translating said inter-adapter representation into said second electronic representation.

30. The system of claim 29 wherein said inter-adapter representation of the contract terms is a representation in one selected from the group consisting of:

extensible markup language (XML), simple object access protocol (SOAP), web services description language (WSDL), and universal description, discovery and integration (UDDI).

31. A method comprising:

storing to computer-readable medium a first electronic representation of rate terms of at least one contract between an insurer and a service provider;

using said first electronic representation of rate terms by a claim adjudication application for adjudicating claims submitted to the insurer by said service provider;

importing the rate terms from the first electronic representation to a second electronic representation of the at least one contract stored to computer-readable medium; and

using said second electronic representation of the at least one contract by a contract management application for managing the at least one contract.

32. The method of claim 31 wherein said electronically representing said rate terms comprises:

associating at least one qualifier and a corresponding calculation method with at least one rate term of said contract.

33. The method of claim 31 wherein said first electronic representation of said rate terms is not compatible with said contract management application.

34. The method of claim 33 wherein said importing comprises:

translating the first electronic representation of the rate terms into said second electronic representation that is compatible with said contract management application.

35. A system comprising:

means for storing a first electronic representation of contract terms, wherein said first electronic representation of the contract terms has a first format that is compatible with an adjudication application; and

means for generating, from the first electronic representation of contract terms, at least a portion of a second electronic representation of the contract, wherein said second electronic representation of the contract has a second format that is compatible with a contract management application.

36. The system of claim 35 wherein said first format is not compatible with said contract management application.

37. The system of claim 35 wherein said contract is between an insurer and a service provider, and wherein said adjudication application is a claim adjudication application for processing claims submitted to the insurer from the service provider to determine a payment amount for said claims in accordance with the contract.