AUTOMATION OF AUDITING CLAIMS

• US 20100305977A1
• 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 8,346,577 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 10/10 Office automation; Time management
• CPC Class Codes: G06Q 20/102 Bill distribution or payments
• CPC Class Codes: G06Q 30/0222 During e-commerce, i.e. online transactions
• CPC Class Codes: G06Q 40/00 Finance; Insurance; Tax strategies; Processing of corporate or income taxes
• CPC Class Codes: G06Q 40/08 Insurance

Abstract

Described are computer-based methods and apparatuses, including computer program products, for automation of auditing claims. A data file is received comprising one or more auditable items, each auditable item comprising a word string having one or more words. Each word string for each auditable item is translated using one or more translation steps into a translated item description. Each translated item description is compared to a plurality of terms to generate matching information. Each translated item description is associated with an item identifier based on the matching information. Each auditable item is accepted or rejected based on the item identifier and one or more rules associated with the data file.

Claims

1. A computerized auditing method comprising:

receiving, via a processor, a data file comprising one or more auditable items, each auditable item comprising a word string having one or more words;

translating, using the processor, each word string for each auditable item using one or more translation steps into a translated item description;

comparing, using the processor, each translated item description to a plurality of terms to generate matching information;

associating, using the processor, each translated item description with an item identifier based on the matching information; and

accepting, using the processor, or rejecting each auditable item based on the item identifier and one or more rules associated with the data file.

2. The method of claim 1 further comprising:

determining the item identifier is rejected for an auditable item; and

rejecting the auditable item;

or

determining the item identifier is accepted for the auditable item; and

accepting the auditable item.

3. The method of claim 1 further comprising:

unsuccessfully translating a word string into a translated item description; and

logging the word string as an unsuccessful translation.

4. The method of claim 1, further comprising:

unsuccessfully associating a translated item description with a single item identifier; and

associating the translated item description with a plurality of item identifiers.

5. The method of claim 1, wherein translating comprises preprocessing the word string.

6. The method of claim 5, wherein preprocessing comprises removing one or more orientation words from the word string, removing one or more unnecessary words from the word string, adding a space before one or more punctuation marks in the word string, or any combination thereof.

7. The method of claim 1, wherein translating the word string comprises:

determining the word string comprises one or more standard words from a plurality of standard words; and

removing the one or more standard words from the word string.

8. The method of claim 1, wherein translating the word string comprises:

determining word string comprises one or more specific words from a plurality of specific words; and

for each specific word from the one or more specific words, processing the word string based on the specific word.

9. The method of claim 8, wherein the plurality of specific words comprise predetermined word strings, structural part groupings, abbreviations, metric indicators, computer generated formats, non-alphanumeric characters, single letters, or any combination thereof.

10. The method of claim 9, wherein the metric indicators are alphanumeric, alpha, and numerical characters dealing with metrics.

11. The method of claim 1, wherein translating the word string comprises:

determining the word string comprises one or more abbreviations from a plurality of abbreviations; and

for each abbreviation from the one or more abbreviations, processing the word string based on the abbreviation.

12. The method of claim 1, wherein translating the word string comprises:

determining the word string comprises header information; and

processing the word string based on the header information.

13. The method of claim 1, wherein translating the word string comprises:

determining the word string comprises one or more ambiguous words from a plurality of ambiguous words; and

processing the word string based on the one or more ambiguous words.

14. The method of claim 1, wherein translating the word string comprises:

applying one or more rules from a plurality of rules to the word string, wherein each rule is associated with a logic for processing the word string;

determining whether the word string contains one or more predetermined items; and

if the word string contains one or more predetermined items, for each predetermined item, processing the word string based on the predetermined item.

15. The method of claim 14 further comprising, for each predetermined item:

determining whether the word string satisfies a condition associated with the predetermined item; and

if the word string satisfies the condition, generating the translated item description.

16. The method of claim 15 further comprising:

determining whether the translated item description was not generated; and

if the translated item description was not generated, generating the translated item description based on a statistical estimation.

17. The method of claim 14, wherein the one or more rules comprises one or more specific item rules, one or more combination rules, or any combination thereof.

18. The method of claim 14, wherein the one or more predetermined items comprises one or more terms, one or more punctuation marks, or any combination thereof.

19. The method of claim 14, further comprising:

determining the word string comprises one word; and

generating the translated item description to include the one word.

20. The method of claim 1, wherein translating the word string comprises:

applying one or more combination rules to the word string, wherein each rule is associated with a logic for processing the word string;

comparing the word string against a build table to generate a relationship between the one or more words of the word string, the build table comprising one or more index words, each index word being associated with index information; and

generating the translated item description based on the relationship.

21. The method of claim 20, further comprising:

determining whether the word string comprises one or more predetermined items; and

for each predetermined item of the word string, processing the word string based on the predetermined item.

22. The method of claim 20, wherein the index information comprises noun information, adjective information, orientation information, or any combination thereof.

23. The method of claim 20, wherein comparing comprises, for each word in the word string:

determining whether the word is an orientation word;

if the word is an orientation word, modifying the word string based on the orientation word;

if the word is not an orientation word;

determining whether one or more remaining words in the word string match a list of preceding terms;

for each word that matches the list of preceding terms, recording a preceding relationship;

determining whether one or more remaining words in the word string match a list of anteceding terms; and

for each word that matches the list of anteceding terms, recording an anteceding relationship.

24. The method of claim 20, further comprising:

determining at least one word of the word string is not associated with a relationship; and

processing one or more non-orientation words of the word string.

25. The method of claim 24, wherein processing the one or more non-orientation words comprises:

for each non-orientation word of the word string;

determining whether the non-orientation word is associated with a build number;

if the non-orientation word is not associated with a build number, associating the non-orientation word with a generic build number;

arranging the word string based on the relationship;

determining whether the word string satisfies a proper relationship criteria; and

if the word string does not satisfy the proper relationship criteria, logging the word string.

26. The method of claim 20, wherein the one or more predetermined items comprise one or more punctuation marks, one or more joinable words, or any combination thereof.

27. The method of claim 1, wherein:

the data file comprises an automobile insurance demand file; and

the one or more word strings comprise one or more repair part descriptions.

28. The method of claim 27, wherein:

the data file further comprises one or more recommended part descriptions for repair of the vehicle; and

the one or more rules associated with the data file are based on the one or more recommended part descriptions for repair.

29. A computerized auditing method comprising:

receiving, via a processor, a data file comprising one or more auditable items;

extracting, using the processor, a word string from each auditable item;

translating, using the processor, each word string using one or more translation steps into a translated item description;

for each translated item description;

comparing, using the processor, the translated item description to a plurality of terms;

generating, using the processor, a matching table comprising one or more entries, wherein each entry of the matching table comprises a matching term from the plurality of terms and matching information, the matching information comprising a match characteristic between the translated item description and the term and an item identifier;

determining, using the processor, whether the match characteristic for each entry is below a predetermined threshold;

if the match characteristic is below the predetermined threshold, removing, using the processor, the entry from the matching table;

determining, using the processor, if one entry of the matching table comprises a best match;

if one entry comprises the best match, associating, using the processor, the item identifier of the one entry with the translated item description;

if no entry comprises the best match;

determining, using the processor, whether a plurality of entries comprise a similar match indicator value; and

if the plurality of entries comprise the similar match indicator value, associating, using the processor, the item identifier for each of the plurality of entries with the translated item description, otherwise associating the translated item description with a no match indicator;

accepting, using the processor, or rejecting each auditable item associated with an item identifier based on the item identifier and one or more rules associated with the data file; and

generating, using the processor, an audit report.

30. A computerized auditing method comprising:

receiving, via a processor, a data file comprising one or more auditable items, each auditable item comprising a word string having one or more words;

translating, using the processor, each word string into a translated item description, wherein translating comprises;

determining, using the processor, whether the word string comprises a primary name;

if the word string comprises a primary item name, calculating, using the processor, the translated item description based on the primary name; and

if the word string does not comprise a primary item name, calculating, using the processor, the translated item description based on the last word of the word string;

comparing, using the processor, each translated item description to a plurality of predetermined terms to generate matching information;

associating, using the processor, each translated item description with an item identifier based on the matching information; and

accepting, using the processor, or rejecting each auditable item based on the item identifier and one or more rules associated with the data file.

31. A computerized auditing method comprising:

receiving, using the processor, a data file comprising one or more auditable items, each auditable item comprising a word string having one or more words;

translating, using the processor, each word string for each auditable item into a translated item description, wherein translating each word string comprises;

generating, using the processor, relationship information between two or more words of the word string based on a classification of each word of the word string;

determining, using the processor, whether each word of the word string is associated with the relationship information;

if each word of the word string is associated with the relationship information, calculate, using the processor, the translated item description based on the relationship information; and

if each word of the word string is not associated with the relationship information, calculate, using the processor, the translated item description based on ordering information;

comparing, using the processor, each translated item description to a plurality of predetermined terms to generate matching information;

associating, using the processor, each translated item description with an item identifier based on the matching information; and

accepting, using the processor, or rejecting each auditable item based on the item identifier and one or more rules associated with the data file.

32. A apparatus comprising:

an auditing system configured to receive a data file comprising one or more auditable items, each auditable item comprising a word string having one or more words; and

a translator in communication with the auditing apparatus configured to;

translate each word string for each auditable item using one or more translation steps into a translated item description;

compare each translated item description to a plurality of terms to generate matching information;

associate each translated item description with an item identifier based on the matching information; and

accept or reject each auditable item based on the item identifier and one or more rules associated with the data file.

33. The apparatus of claim 32 further comprising a text recognition unit in communication with the audit unit and the translator configured to recognize the text of the data file.

34. The apparatus of claim 32 further comprising an output unit configured to generate an audit report, the audit report comprising an audit result for each auditable item of the data file.

35. The apparatus of claim 32 further comprising a database in communication with the translator configured to store one or more rules, the one or more rules being used to translate the word string.

36. 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 a data file comprising one or more auditable items, each auditable item comprising a word string having one or more words;

translate each word string for each auditable item using one or more translation steps into a translated item description;

compare each translated item description to a plurality of terms to generate matching information;

associate each translated item description with an item identifier based on the matching information; and

accept or rejecting each auditable item based on the item identifier and one or more rules associated with the data file.

37. An apparatus comprising:

means for receiving a data file comprising one or more auditable items, each auditable item comprising a word string having one or more words;

means for;

translating each word string for each auditable item using one or more translation steps into a translated item description;

comparing each translated item description to a plurality of terms to generate matching information;

associating each translated item description with an item identifier based on the matching information; and

accepting or rejecting each auditable item based on the item identifier and one or more rules associated with the data file.