RULE GENERATION SYSTEM ADAPTED FOR AN INSURANCE CLAIM PROCESSING SYSTEM

• US 20090216803A1
• Filed: 02/22/2008
• Published: 08/27/2009
• Est. Priority Date: 02/22/2008
• Status: Active Grant

• Current Assignee: DUCK Creek Technologies Incorporated
• Original Assignee: Accenture Global Services Limited (Accenture PLC)
• Inventors: Goldfarb, Eugene
• Granted Patent: US 8,515,786 B2
• Time in Patent Office: Days
• US Class Current: 1/1
• CPC Class Codes: G06Q 40/08 Insurance

Abstract

A rule generation system facilitates the dynamic generation of rules for an insurance claim processing computer system. The rule generation system includes various modules and graphical user interfaces that provide a streamlined mechanism for creating new rules for the insurance claim processing architecture. The rule generation system may include various levels of usability that distinguish between an advanced user of the rule generation system and basic user that uses the generated rules. The rule generation system may also include graphical user interfaces directed to adding, editing, removing, or maintaining rules for the insurance claim processing computer system.

Claims

1. A rule generation system comprising:

a memory storage device comprising;

an evaluative expression framework defining an evaluative expression category;

an evaluative expression parameter associated with the evaluative expression category, wherein the evaluative expression parameter defines the evaluative expression category type of an evaluative expression; and

executable instructions that define;

an evaluative expression parameter module operative to receive an evaluative expression parameter value that represents the evaluative expression category type for the evaluative expression parameter; and

an evaluative expression generator module operative to generate an evaluative expression using the received evaluative expression parameter value, wherein the evaluative expression defines a conditional statement that corresponds to the evaluative expression category type; and

a processor operative to execute the executable instructions.

2. The rule generation system of claim 1, wherein:

the evaluative expression category comprises a navigation evaluative expression category;

the evaluative expression parameter is further associated with the navigation evaluative expression category; and

the evaluative expression parameter module is further operative to;

implement an edit-navigation-evaluative-expression communication interface; and

display the evaluative expression parameter with the edit-navigation-evaluative-expression communication interface.

3. The rule generation system of claim 2, wherein:

the evaluative expression category is a first evaluative expression category;

the evaluative expression parameter is a first evaluative expression parameter;

the evaluative expression framework further defines;

a second evaluative expression category comprising a display evaluative expression category;

a third evaluative expression category comprising a discrepancy evaluative expression category;

a second evaluative expression parameter that defines a property of a display evaluative expression and is associated with the second evaluative expression category; and

a third evaluative expression parameter that defines a property of a discrepancy evaluative expression and is associated with the third evaluative expression category; and

the evaluative expression parameter module is further operative to;

implement an edit-display-evaluative-expression communication interface;

implement an edit-discrepancy-evaluative-expression communication interface;

display the second evaluative expression parameter with the edit-display-evaluative-expression communication interface; and

display the third evaluative expression parameter with the edit-discrepancy-evaluative-expression communication interface.

4. The rule generation system of claim 1, wherein:

the evaluative expression is a first evaluative expression; and

executable instruction sets further define;

a common evaluative expression module operative to receive a common evaluative expression parameter value that defines a second evaluative expression as a common portion of the first evaluative expression.

5. The rule generation system of claim 4, wherein the common evaluative expression module is further operative to:

implement an add-common-evaluative-expression communication interface operative to associate a first common evaluative expression parameter value with the second evaluative expression; and

implement a display-common-evaluative-expression communication interface operative to display a second common evaluative expression parameter value previously associated with the second evaluative expression.

6. The rule generation system of claim 4, wherein the evaluative expression generator module is further operative to generate the first evaluative expression using the common evaluative expression parameter value received by the common evaluative expression module.

7. The rule generation system of claim 1, wherein:

the executable instruction sets further define;

an advanced evaluative expression module operative to receive an advanced evaluative expression parameter value that defines an advanced portion of the evaluative expression, wherein the advanced evaluative expression parameter comprises an advanced evaluative expression operand that defines an operand of the advanced portion of the evaluative expression; and

the evaluative expression generator module is further operative to generate the evaluative expression based on the advanced evaluative expression parameter value received by the advanced evaluative expression module.

8. The rule generation system of claim 1, wherein the executable instruction sets further define:

a discrepancy evaluative expression module operative to associate a message with the evaluative expression generated by the evaluative expression generator module, wherein the message is displayed when the evaluative expression is evaluated to a predetermined value.

10. The method of claim 1, wherein the evaluative expression category comprises a navigation evaluative expression category, and further comprising:

associating the evaluative expression parameter with the navigation evaluative expression category;

implementing an edit-navigation-evaluative-expression communication interface; and

displaying the evaluative expression parameter with the edit-navigation-evaluative-expression communication interface.

11. The method of claim 10, wherein:

the evaluative expression category is a first evaluative expression category;

the evaluative expression parameter is a first evaluative expression parameter; and

further comprising;

defining a second evaluative expression category that comprises a display evaluative expression category;

defining a third evaluative expression category that comprises a discrepancy evaluative expression category;

associating a second evaluative expression parameter that defines a property of a display evaluative expression and is with the second evaluative expression category;

associating a third evaluative expression parameter that defines a property of a discrepancy evaluative expression and is associated with the third evaluative expression category;

implementing an edit-display-evaluative-expression communication interface;

implementing an edit-discrepancy-evaluative-expression communication interface;

displaying the second evaluative expression parameter with the edit-display-evaluative-expression communication interface; and

displaying the third evaluative expression parameter with the edit-discrepancy-evaluative-expression communication interface.

9. A method for generating rules comprising:

implementing an evaluative expression framework defining an evaluative expression category;

associating an evaluative expression parameter with the evaluative expression category, wherein the evaluative expression parameter defines the evaluative expression category type of an evaluative expression;

receiving an evaluative expression parameter value that represents the evaluative expression category type for the evaluative expression parameter; and

generating an evaluative expression using the received evaluative expression parameter value, wherein the evaluative expression defines a conditional statement that corresponds to the evaluative expression category type.

12. The method of claim 9, wherein the evaluative expression is a first evaluative expression and further comprising:

receiving a common evaluative expression parameter value that defines a second evaluative expression as a common portion of the first evaluative expression.

13. The method of claim 12, further comprising:

implementing an add-common-evaluative-expression communication interface to associate the common evaluative expression parameter value with the second evaluative expression; and

implementing a display-common-evaluative-expression communication interface to display the common evaluative expression parameter value associated with the second evaluative expression.

14. The method of claim 12, wherein generating the first evaluative expression comprises generating the first evaluative expression using the received common evaluative expression parameter value.

15. The method of claim 9, further comprising:

receiving an advanced evaluative expression parameter value that defines an advanced portion of the evaluative expression, wherein the advanced evaluative expression parameter comprises an advanced evaluative expression operand that defines an operand of the advanced portion of the evaluative expression; and

wherein generating the evaluative expression comprises generating the evaluative expression based on the received advanced evaluative expression parameter value.

16. The method of claim 9, further comprising:

associating a message with the previously generated evaluative expression, wherein the message is displayed when the evaluative expression is evaluated to a predetermined value.

17. A product comprising:

a machine readable medium; and

logic stored on the machine readable medium operative to;

implement an evaluative expression framework defining an evaluative expression category;

receive an evaluative expression parameter value for the evaluative expression parameter, wherein the evaluative expression parameter defines the evaluative expression category type of an evaluative expression; and

generate an evaluative expression using the received evaluative expression parameter value, wherein the evaluative expression defines a conditional statement that corresponds to the evaluative expression category type.

18. The product of claim 17, wherein:

the evaluative expression category comprises a navigation evaluative expression category;

the evaluative expression parameter is further associated with the navigation evaluative expression category; and

the logic is further operative to;

implement an edit-navigation-evaluative-expression communication interface; and

display the evaluative expression parameter with the edit-navigation-evaluative-expression communication interface.

19. The product of claim 18, wherein:

the evaluative expression category is a first evaluative expression category;

the evaluative expression parameter is a first evaluative expression parameter;

the evaluative expression framework further defines;

a second evaluative expression category comprising a display evaluative expression category;

a third evaluative expression category comprising a discrepancy evaluative expression category;

a second evaluative expression parameter that defines a property of a display evaluative expression and is associated with the second evaluative expression category; and

a third evaluative expression parameter that defines a property of a discrepancy evaluative expression and is associated with the third evaluative expression category; and

the logic is further operative to;

implement an edit-display-evaluative-expression communication interface;

implement an edit-discrepancy-evaluative-expression communication interface;

display the second evaluative expression parameter with the edit-display-evaluative-expression communication interface; and

display the third evaluative expression parameter with the edit-discrepancy-evaluative-expression communication interface.

20. The product of claim 17, wherein:

the evaluative expression is a first evaluative expression; and

the logic is further operative to;

receive a common evaluative expression parameter value that defines a second evaluative expression as a common portion of the first evaluative expression.

21. The product of claim 20, wherein the logic is further operative to:

implement an add-common-evaluative-expression communication interface operative to associate a first common evaluative expression parameter value with the second evaluative expression; and

implement a display-common-evaluative-expression communication interface operative to display a second common evaluative expression parameter value previously associated with the second evaluative expression.

22. The product of claim 20, wherein the logic is further operative to generate the first evaluative expression using the received common evaluative expression parameter value.

24. The product of claim 17, wherein the logic is further operative to:

associate a message with the previously generated evaluative expression, wherein the message is displayed when the evaluative expression is evaluated to a predetermined value.

23. The product of 17, wherein the logic is further operative to:

receive an advanced evaluative expression parameter value that defines an advanced portion of the evaluative expression, wherein the advanced evaluative expression parameter comprises an advanced evaluative expression operand;

that defines an operand of the advanced portion of the evaluative expression and

generate the evaluative expression based on the received advanced evaluative expression parameter value.