Method, system and computer program code for automatically generating software for reformatting incoming data

• US 20070250351A1
• Filed: 04/25/2006
• Published: 10/25/2007
• Est. Priority Date: 04/25/2006
• Status: Active Grant

• Current Assignee: Conduent Business Services, LLC (Conduent, Inc.)
• Original Assignee: ACS State & Local Solutions Incorporated (Conduent, Inc.)
• Inventors: Szlam, Aleksander
• Granted Patent: US 8,065,168 B2
• Time in Patent Office: Days
• US Class Current: 705/4
• CPC Class Codes: G06Q 10/06 Resources, workflows, human or project management; Enterprise or organisation planning; Enterprise or organisation modelling
• CPC Class Codes: G06Q 10/087 Inventory or stock management, e.g. order filling, procurement or balancing against orders
• CPC Class Codes: G06Q 40/08 Insurance
• CPC Class Codes: Y10S 707/99933 Query processing, i.e. searching

Abstract

A method, system and computer program product are provided for creating software that can be used to reformat incoming insurance-related data into a format that conforms to the requirements or preferences of the receiving party. In particular, the software generated is capable of causing a particular action to be taken which will result in the transfer of the received data from one format to another in response to certain conditions being met. These conditions are defined by a decision table, from which the software is automatically generated. A means is further provided for using the received data, which has been reformatted where necessary, to create a user-friendly table that defines the rules and parameters of a particular insurance policy. The table is capable of being easily understood by those unfamiliar with the intricacies of insurance claim processing and programming code, and is further capable of being read by a claims processing engine when processing an insurance claim.

Claims

1. A method of creating software for reformatting insurance related data received from a first party to a format that is acceptable to a second party, said method comprising:

creating a decision table based on a combination of conditions defining when a respective one of a plurality of reformatting actions should be taken with respect to the data received;

providing the decision table to a software generator; and

automatically generating computer programming instructions based upon the decision table and configured to cause the respective reformatting action to be taken based on the combinations of conditions from the decision table upon execution thereof.

2. The method of claim 1, wherein the first party offers one or more insurance policies to one or more third parties, and wherein the second party processes insurance claims submitted by the third parties under the insurance policies.

3. The method of claim 2, wherein the insurance related data comprises data relating to one or more providers authorized under a respective insurance policy offered by the first party.

4. The method of claim 2, wherein the insurance related data comprises data relating to one or more benefits under a respective insurance policy offered by the first party.

5. The method of claim 2, wherein the insurance related data comprises data relating to one or more eligibility requirements for a respective insurance policy offered by the first party.

6. The method of claim 1, wherein creating a decision table is repeated for each of the plurality of reformatting actions, such that a different decision table is created for each reformatting action based on a different combination of conditions defining when the reformatting action, with which the decision table is associated, should be taken.

7. The method of claim 4, wherein providing the decision table to the software generator is repeated for each of the different decision tables, such that for each of the different decision tables, a different set of computer programming instructions is automatically generated that causes the respective reformatting action, with which the decision table is associated, to be taken based on the combination of conditions from the decision table.

8. The method of claim 1, wherein the plurality of reformatting actions include moving one field of the insurance related data from one location to another location, translating the contents of one field, or looking up the contents of one field in a database.

9. A system for creating software for reformatting insurance related data received from a first party to a format that is acceptable to a second party, said system comprising:

a software generator; and

a decision table instantiated in a memory device and accessible by the software generator, said decision table defining a combination of conditions that must occur in order for a respective one of a plurality of reformatting actions to be taken with respect to the data received,

wherein the software generator automatically generates computer programming instructions based upon the decision table and configured to cause the respective reformatting action to be taken based on the combination of conditions from the decision table upon execution thereof.

10. The system of claim 9, wherein the second party processes one or more insurance policy claims received under one or more insurance policies offered by the first party, and wherein said insurance related data assists the second party in processing the claims.

11. The system of claim 10, wherein the insurance related data comprises data relating to one or more providers authorized under a respective insurance policy offered by the first party.

12. The system of claim 10, wherein the insurance related data comprises data related to one or more benefits under a respective insurance policy offered by the first party.

13. The system of claim 10, wherein the insurance related data comprises data related to one or more eligibility requirements for a respective insurance policy offered by the first party.

14. The system of claim 9 further comprising a plurality of decision tables, wherein each of the plurality of decision tables defines a different combination of conditions that must be met in order for a respective one of the plurality of reformatting actions to be taken.

15. The system of claim 14, wherein for each of the plurality of decision tables, the software generator automatically generates a set of computer programming instructions that causes the respective reformatting action, with which the decision table is associated, to be taken based on the combination of conditions from the decision table.

16. A computer program product for reformatting insurance related data received from a first party to a format that is acceptable to a second party, wherein the computer program product comprises at least one computer-readable storage medium having computer-readable program code portions stored therein, the computer-readable program code portions comprising:

a first executable portion for receiving a decision table, said decision table defining a combination of conditions that must occur for a respective one of a plurality of reformatting actions to be taken with respect to the data received; and

a second executable portion for automatically generating computer programming instructions based upon the decision table and configured to cause the respective reformatting action to be taken based on the combination of conditions from the decision table upon execution thereof.

17. The computer program product of claim 16 further comprising:

a third executable portion for enabling a user to create the decision table.

18. The computer program product of claim 16, wherein the first party offers one or more insurance policies to one or more third parties, and wherein the second party processes one or more insurance policy claims submitted by the third parties under the insurance policies.

19. The computer program product of claim 18, wherein the insurance related data assists the second party in processing the claims submitted.

20. A method of processing an insurance claim, said method comprising:

receiving policy information associated with a particular insurance policy, wherein the policy information comprises a plurality of rules that define one or more benefits under the insurance policy;

organizing the plurality of rules into a predefined tabular format;

providing a claims processing engine with the organized plurality of rules; and

thereafter processing the insurance claim in accordance with the plurality of rules.

21. The method of claim 20, wherein organizing the plurality of rules into a predefined tabular format comprises organizing the rules into a table having one or more fields associated with respective one or more elements of the insurance policy.

22. The method of claim 21 further comprising updating the table with one or more additional rules associated with the insurance policy.

23. The method of claim 21 further comprising changing one or more of the complex rules by changing the contents of one or more fields of the table.

24. The method of claim 20, wherein processing the insurance claim comprises determining the benefit for which the party who submitted the insurance claim is eligible.

25. The method of claim 24, wherein processing the insurance claim further comprises determining whether a service associated with the insurance claim is covered by the insurance policy.

26. The method of claim 25, wherein processing the insurance claim further comprises determining whether a provider associated with the insurance claim is authorized to perform the service.