Service Identification And Decomposition For A Health Care Enterprise

• US 20090210499A1
• Filed: 02/14/2008
• Published: 08/20/2009
• Est. Priority Date: 02/14/2008
• Status: Active Grant

• Current Assignee: Aetna Incorporated (CVS Health Corporation)
• Original Assignee: Aetna Incorporated (CVS Health Corporation)
• Inventors: Singh, Harshwinder, Upadhyayula, Prakash, Brey, Kari
• Granted Patent: US 8,484,044 B2
• Time in Patent Office: Days
• US Class Current: 709/206
• CPC Class Codes: G06Q 10/06 Resources, workflows, human or project management; Enterprise or organisation planning; Enterprise or organisation modelling
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 40/08 Insurance
• CPC Class Codes: G16H 40/67 for remote operation

Abstract

In embodiments, a health insurance computer application enterprise system is provided employing a service oriented architecture (SOA) with a service granularity component that dynamically customizes a reusable service based on one or more of user identity element, service data elements, and service action elements parsed from service request parameters. The health insurance enterprise system includes a plurality of applications making use of functionality provided by a reusable service. In an embodiment, the health insurance enterprise system includes a customer service application, a consumer web portal application, and an integrated voice response (IVR) application. The applications provide different channels of communicating health insurance data to various health insurance system constituents by presenting customized views of the data tailored to a given communications method, user access rights, as well as other factors.

Claims

1. A health care enterprise computer system comprising:

a plurality of health care applications for communicating health care information across the enterprise via a service oriented architecture;

a granularity component for dynamically customizing a reusable service within the service oriented architecture, the reusable service delivering the health care information to the plurality of health care applications; and

wherein the granularity component customizes the reusable service for each of the plurality of health care applications based on service request parameters comprising one or more of user identification fields, requested data fields, and requested action fields.

2. The system of claim 1 wherein the granularity component is capable of transforming a message format of the reusable service to a different service message format.

3. The system of claim 1 wherein said each of the plurality of health care applications is selected from the group consisting of a customer service application, a consumer web portal application, and an integrated voice response application.

4. The system of claim 1 wherein the reusable service comprises a service for retrieving health insurance plan member information.

5. The system of claim 4 wherein the reusable service is decomposed into one or more reusable services for getting the member'"'"'s coverage eligibility status, getting the member'"'"'s health insurance claim detail, and finding one or more other members related to the member.

6. The system of claim 5 wherein the reusable service for finding one or more other members related to the member includes multiple levels of granularity by accepting input of one or more of member'"'"'s name, zip code, and address.

7. The system of claim 1 wherein the reusable service comprises a service for retrieving health insurance plan member'"'"'s health plan benefit information.

8. The system of claim 7 wherein the reusable service is decomposed into one or more reusable services for identifying the member, getting health plan sponsor information, getting health plan sponsor entitlement information, getting health plan details, getting member coverage eligibility, and getting history of member coverage eligibility updates.

9. In a service oriented architecture for a health care enterprise computer system, a method for providing a reusable service to a plurality of health care applications, the method comprising:

receiving a service request from at least one of the plurality of health care applications;

parsing the service request to identify one or more of user identification fields, requested data fields, and requested action fields;

dynamically customizing the reusable service for the at least on of the plurality of health care applications based on one or more of the parsed service request fields; and

invoking the customized reusable service.

10. The method of claim 9 further comprising transforming a message format of the reusable service to a different service message format.

11. The method of claim 9 wherein said at least one of the plurality of health care applications is selected from the group consisting of a customer service application, a consumer web portal application, and an integrated voice response application.

12. The method of claim 9 wherein the reusable service comprises a service for retrieving health insurance plan member information.

13. The method of claim 12 further comprising decomposing the reusable service into one or more additional reusable services for getting the member'"'"'s coverage eligibility status, getting the member'"'"'s health insurance claim detail, and finding one or more other members related to the member.

14. The method of claim 13 wherein the reusable service for finding one or more other members related to the member includes multiple levels of granularity by accepting input of one or more of member'"'"'s name, zip code, and address.

15. The method of claim 9 wherein the reusable service comprises a service for retrieving health insurance plan member'"'"'s health plan benefit information.

16. The method of claim 15 further comprising decomposing the reusable service into one or more reusable services for identifying the member, getting health plan sponsor information, getting health plan sponsor entitlement information, getting health plan details, getting member coverage eligibility, and getting history of member coverage eligibility updates.

17. In a service oriented architecture for a health care enterprise computer system, a computer readable medium having stored thereon computer executable instructions for providing a reusable service to a plurality of health care applications, the instructions comprising:

receiving a service request from at least one of the plurality of health care applications;

parsing the service request to identify one or more of user identification fields, requested data fields, and requested action fields;

dynamically customizing the reusable service for the at least on of the plurality of health care applications based on one or more of the parsed service request fields; and

invoking the customized reusable service.

18. The computer readable medium of claim 17 wherein the reusable service comprises a service for retrieving health insurance plan member information, the instructions further comprising decomposing the reusable service into one or more additional reusable services for getting the member'"'"'s coverage eligibility status, getting the member'"'"'s health insurance claim detail, and finding one or more other members related to the member.

19. The computer readable medium of claim 18 wherein the reusable service for finding one or more other members related to the member includes multiple levels of granularity by accepting input of one or more of member'"'"'s name, zip code, and address.

20. The computer readable medium of claim 17 wherein the reusable service comprises a service for retrieving health insurance plan member'"'"'s health plan benefit information, the instructions further comprising decomposing the reusable service into one or more reusable services for identifying the member, getting health plan sponsor information, getting health plan sponsor entitlement information, getting health plan details, getting member coverage eligibility, and getting history of member coverage eligibility updates.