AUTOMATION OF AUDITING CLAIMS

• US 20100305941A1
• Filed: 05/29/2009
• Published: 12/02/2010
• Est. Priority Date: 05/29/2009
• Status: Active Grant

• Current Assignee: HyperQuest, Inc. (Solera Holdings Incorporated)
• Original Assignee: HyperQuest, Inc. (Solera Holdings Incorporated)
• Inventors: Hogan, Jeffrey J., Hogan, Dennis M.
• Granted Patent: US 8,255,205 B2
• Time in Patent Office: Days
• US Class Current: 704/9
• CPC Class Codes: G06F 40/237 Lexical tools

Abstract

Described are computer-based methods and apparatuses, including computer program products, for automation of auditing claims. Data indicative of an insurance company name is received, the data comprising one or more words. The data is processed through one or more processing steps to generate processed data comprising one or more processed words. One or more candidate word strings are selected based on the one or more processed words. Matching information is associated with each of the one or more candidate word strings. Analysis information is generated for each of the one or more candidate word strings based on the associated matching information. An insurance company identifier is associated with received data based on the analysis information and one or more matching rules.

Claims

1. A computerized method comprising:

receiving, via a processor, data indicative of an insurance company name, the data comprising one or more words;

processing, using the processor, the data through one or more processing steps to generate processed data comprising one or more processed words;

selecting, using the processor, one or more candidate word strings based on the one or more processed words;

associating, using the processor, matching information with each of the one or more candidate word strings;

generating, using the processor, analysis information for each of the one or more candidate word strings based on the associated matching information; and

associating, using the processor, an insurance company identifier with received data based on the analysis information and one or more matching rules.

2. The method of claim 1, wherein processing the data through one or more processing steps to generate processed data comprising one or more processed words comprises:

identifying a hyphenated word and replacing the hyphenated word in the data indicative of an insurance company name with a predetermined word string;

identifying a state abbreviation word, identifying a position of the state abbreviation word in the data indicative of an insurance company name, and associating an identifier with the data indicative of the position;

or

identifying a punctuation mark in the data indicative of an insurance company name, inserting a space before the punctuation mark, and inserting a space after the punctuation mark, or any combination thereof.

3. The method of claim 1, wherein processing the data through one or more processing steps to generate processed data comprising one or more processed words comprises:

determining whether each word of the data is spelled correctly based on a predetermined list of words; and

if a word is spelled incorrectly, associating the word with an identifier indicative of the word being spelled incorrectly;

or

if a word is spelled correctly, associating the word with an identifier indicative of the word being spelled correctly.

4. The method of claim 3, further comprising:

associating an identifier with each word of the data indicative of a word usage for the word;

determining whether each word is a location word; and

if a word is a location word, associating the word with an identifier indicative of the word being a location word.

5. The method of claim 3, further comprising generating processed data based on a number of words in the data indicative of an insurance company name, a number of words associated with an identifier indicative of the word being spelled correctly, or both.

6. The method of claim 1, wherein selecting one or more candidate word strings based on the one or more processed words comprises identifying the data indicative of an insurance company name comprises a definitive word pattern.

7. The method of claim 1, wherein selecting one or more candidate word strings based on the one or more processed words comprises:

calculating a number of words in the data indicative of an insurance company name; and

associating an identifier indicative of the number of words with the data.

8. The method of claim 1, wherein selecting one or more candidate word strings based on the one or more processed words comprises:

determining whether the data includes two or more words with a same usage number;

selecting a first word in the data, wherein the first word has an earliest location in the data of the two or more words with the same usage number; and

selecting the one or more candidate word strings based on the first word.

9. The method of claim 1, wherein the matching information associated with each of the one or more candidate word strings comprises a number of words in the data indicative of an insurance company name, a sequence of words in the data, an identifier indicative of whether a location word exists in the data, a location of a location word in the data, or any combination thereof.

10. The method of claim 1, wherein generating analysis information for each of the one or more candidate word strings based on the associated matching information comprises:

determining whether a location word is in the data, the location word being indicative of an insurance company name; and

if there is a location word, for each location word;

determining a position of the location word in the data indicative of an insurance company name; and

associating the word with an identifier indicative of the position.

11. The method of claim 10, further comprising calculating a weighted word match count based on a word usage number for the data indicative of an insurance company name, the one or more candidate word strings, or both.

12. The method of claim 11, further comprising calculating a sequence number count based on a difference in relative sequence of a lowest usage word in the data indicative of an insurance company name and each of the one or more candidate word strings.

13. The method of claim 12, wherein the lowest usage word is a word used least in the data indicative of an insurance company name.

14. The method of claim 10, further comprising calculating an average absolute sequence number count for each of the one or more candidate word strings based on a difference in relative sequence of a word in the data indicative of an insurance company name and the candidate word string.

15. The method of claim 1, wherein associating an insurance company identifier with received data based on the analysis information and one or more matching rules comprises associating the insurance company identifier based on a word usage number and a number of candidate word string matches.

16. An apparatus comprising:

an auditing system configured to receive data indicative of an insurance company name, the data comprising one or more words; and

an insurance company name translator in communication with the auditing system configured to;

process the data through one or more processing steps to generate processed data comprising one or more processed words;

select one or more candidate word strings based on the one or more processed words;

associate matching information with each of the one or more candidate word strings;

generate analysis information for each of the one or more candidate word strings based on the associated matching information; and

associate an insurance company identifier with received data based on the analysis information and one or more matching rules.

17. A computer program product, tangibly embodied in a computer readable storage medium, the computer program product including instructions being operable to cause a data processing apparatus to:

receive data indicative of an insurance company name, the data comprising one or more words;

process the data through one or more processing steps to generate processed data comprising one or more processed words;

select one or more candidate word strings based on the one or more processed words;

associate matching information with each of the one or more candidate word strings;

generate analysis information for each of the one or more candidate word strings based on the associated matching information; and

associate an insurance company identifier with received data based on the analysis information and one or more matching rules.

18. An apparatus comprising:

means for receiving data indicative of an insurance company name, the data comprising one or more words; and

means for;

processing the data through one or more processing steps to generate processed data comprising one or more processed words;

selecting one or more candidate word strings based on the one or more processed words;

associating matching information with each of the one or more candidate word strings;

generating analysis information for each of the one or more candidate word strings based on the associated matching information; and

associating an insurance company identifier with received data based on the analysis information and one or more matching rules.