Processing health care transactions using a semantic network

• US 20060173672A1
• Filed: 10/07/2003
• Published: 08/03/2006
• Est. Priority Date: 07/27/2000
• Status: Abandoned Application

• Current Assignee: HealthEdge, Inc.
• Original Assignee: HealthEdge, Inc.
• Inventors: Morris, John, Easton, Chris, Kennedy, Andrew, Kennedy, James, Krylov, Eugene, Vujisic, Lyubomir, Yoshida, Andre, Bergeron, Heather Ellen, Koen, Doug, Pringle, Simone Lemos, Peled, Alon, Pai, Jayant, Trustman, John
• Application Number:
  US10/681,052
• Publication Number:
  US 20060173672A1
• Time in Patent Office: Days
• US Class Current: 704/9
• CPC Class Codes: G06F 40/20 Natural language analysis semantic analysis of natural language G06F40/30

Abstract

The disclosed technology can execute a sequence of transactions to process a request associated with a health care company and/or other entities interacting in a health care industry. Execution of at least some of the transaction sequence can result in the formation of an instance of a semantic network that can be used to support such processing. The request can correspond to a change in a relationship associated with such entities, where such request corresponds to an electronic document exhibiting a structured natural language format with a fixed context and a fixed grammar.

Claims

1. A method, comprising:

receiving a request associated with a health care company;

identifying a sequence of transactions associated with the request;

executing at least some of the transaction sequence to form an instance of a semantic network, the semantic network instance including at least one relationship associated with the health care company; and

processing the request based, at least in part, on the semantic network instance.

2. The method of claim 1, wherein the request is further associated with at least one of a health care subscriber, a health care supplier, a health care practitioner, and a health care beneficiary.

3. The method of claim 1, further comprising:

storing indicia associated with the request in a data structure; and

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

4. The method of claim 3, further comprising:

based, at least in part, on the at least one date-time indicia of the data structure, re-executing at least some of the transaction sequence to reprocess the request.

5. The method of claim 1, wherein the request is received from an electronic data interchange system.

6. The method of claim 1, wherein the request is received from at least one of an application program interface, a user interface, and a software editing tool.

7. The method of claim 1, further comprising:

representing the request in a natural language format exhibiting a fixed context and a fixed grammar.

8. The method of claim 7, wherein the fixed grammar exhibits a Backus-Naur format.

9. The method of claim 7, 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 transaction sequence.

10. The method of claim 7, further comprising:

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

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

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

12. The method of claim 1, wherein the request corresponds to at least one of a request for payment of services performed, a request to authorize proposed services, a request to enroll a service provider, a request to enroll a service purchaser, a request to enroll a service beneficiary, and an adoption of a new contract.

13. The method of claim 1, further comprising:

forming an electronic message in response to detecting an error during the execution of the transaction sequence.

14. The method of claim 1, wherein indicia associated with the health care company corresponds to at least one of a plurality of nodes in the semantic network instance and the at least one relationship corresponds to at least one link interconnecting the at least one node of the health care company with another of the plurality of nodes in the semantic network instance.

15. The method of claim 1, further comprising:

querying data structures associated with the semantic network instance; and

in response to the query, forming an electronic document containing indicia associated with the health care company and the at least one relationship, wherein the electronic document is viewable in a natural language format exhibiting a fixed context and a fixed grammar.

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

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

at least one node based on a health care supplier.

17. The method of claim 16, wherein the semantic network instance 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 care subscription; and

at least one node based on a health care practitioner.

18. A method, comprising:

receiving a request to change a relationship associated with a plurality of entities interacting within a health care industry, the change request corresponding to an electronic document exhibiting a natural language format with a fixed context and a fixed grammar;

parsing the change request to identify a data structure associated with the health care industry, the data structure including a plurality of entity types and relationship types;

based on at least some of the plurality of entity types and relationship types corresponding to the plurality of entities, identifying a sequence of transactions; and

executing the transaction sequence to process the requested relationship change.

19. The method of claim 18, wherein the fixed grammar corresponds to a Backus-Naur format.

20. The method of claim 18, wherein the plurality of entities correspond to at least two of a health care subscriber, a health care supplier, a health care practitioner, a health care beneficiary, and a health care company.

21. The method of claim 20, wherein the request corresponds to at least one of a request for payment of services performed, a request to authorize proposed services, a request to enroll the health care supplier, a request to enroll the health care subscriber, a request to enroll the health care beneficiary, and an adoption of a new contract.

22. The method of claim 18, further comprising:

storing indicia associated with the change request in a first data structure; and

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

23. The method of claim 22, further comprising:

based, at least in part, on the at least one date-time indicia of the first data structure, re-executing at least some of the transaction sequence to reprocess the requested relationship change.

24. The method of claim 18, wherein the request is received from an electronic data interchange system.

25. The method of claim 18, wherein the request is received from at least one of an application program interface, a user interface, and a software editing tool.

26. The method of claim 18, wherein the requested relationship change corresponds to at least one contractual provision associated with the plurality of entities.

27. The method of claim 18, wherein indicia associated with the plurality of entities correspond to a plurality of nodes in a semantic network and the requested relationship change corresponds to at least one link interconnecting at least some of the plurality of nodes in the semantic network.

28. The method of claim 27, further comprising:

querying the semantic network to obtain data associated with the plurality of entities and the requested relationship change; and

formatting at least some of the obtained data in accordance with the natural language format.

29. The method of claim 27, further comprising:

in response to the execution of at least part of the transaction sequence, forming an instance of the semantic network.