AUTOMATION OF AUDITING CLAIMS

• US 20100305978A1
• 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 8,447,632 B2
• Time in Patent Office: Days
• US Class Current: 705/4
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• 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 comprising make model information, insurance company information, and one or more auditable items, each auditable item comprising a word string having one or more words. The make model information is automatically translated into a vehicle identifier. The insurance company information is automatically translated into an insurance company identifier. The one or more auditable items are automatically translated into one or more groups of identifiers, wherein the one or more groups of identifiers comprises one or more part item identifiers, one or more operational item identifiers, or both. A parts audit report is automatically generated based on the one or more groups of identifiers. An operational audit report is automatically generated. A multi-point estimate is automatically generated based on the parts audit report data and the operational audit report data.

Claims

1. A computerized auditing method comprising:

receiving, via a processor, a data file comprising make model information, insurance company information, and one or more auditable items, each auditable item comprising a word string having one or more words;

automatically translating, using the processor;

the make model information into a vehicle identifier;

the insurance company information into an insurance company identifier; and

the one or more auditable items into one or more groups of identifiers, wherein the one or more groups of identifiers comprises one or more part item identifiers, one or more operational item identifiers, or both;

automatically generating, using the processor, a parts audit report based on the one or more groups of identifiers, the parts audit report comprising data indicative of whether one or more parts of the one or more auditable items is accepted based on one or more rules associated with the insurance company identifier;

automatically generating, using the processor, an operational audit report based on the one or more groups of identifiers, the operational audit report comprising data indicative of whether one or more operations of the one or more auditable items is accepted based on one or more rules associated with the insurance company identifier; and

automatically generating, using the processor, a multi-point estimate based on the parts audit report data and the operational audit report data.

2. The method of claim 1 wherein automatically translating the make model information into a vehicle identifier comprises, for each word string comprising make model information, wherein the make model information comprises one or more make fields and one or more model fields:

preparing the one or more model fields for translation by;

applying one or more rules from a plurality of rules; and

associating each field of the one or more model fields with a class from a list of classes;

preparing the one or more make fields for translation by applying one or more rules from the plurality of rules;

associating each field of the one or more make fields with one or more make model entries from a plurality of predetermined make model entries;

associating each field of the one or more model fields with one or more make model entries from the plurality of predetermined make model entries; and

automatically translating the word string into one or more vehicle identifiers based on the associated make model entries.

3. The method of claim 2, wherein:

the one or more make fields comprise a claim make field and an estimate block make field; and

the one or more model fields comprise a claim model field and an estimate block model field.

4. The method of claim 2, wherein preparing the one or more model fields for translation by applying one or more rules from a plurality of rules comprises:

identifying a model in the one or more model fields that does not need processing;

identifying two words that must be combined into one word, and combining the two words into one word;

identifying a first word that must be separated into two words, and separating the first word into two words;

or identifying a second word as a descriptive classification word, and standardizing a spelling of the second word, or any combination thereof.

5. The method of claim 2, wherein associating each field of the one or more make fields with one or more make model entries from a plurality of predetermined make model entries comprises:

generating a temporary translation table, wherein each row of the temporary translation table comprises a manufacturer field, a make field, a model superset field, and a model subset field;

identifying a match of a make field of the one or more make fields with a predetermined make model entry; and

populating a row of the temporary translation table with match information.

6. The method of claim 1 wherein automatically translating the insurance company information into an insurance company identifier comprises, wherein the insurance company information comprises data comprising one or more words:

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

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

7. The method of claim 6, 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.

8. The method of claim 6, 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.

9. The method of claim 6, 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.

10. The method of claim 6, 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 1 wherein automatically translating the one or more auditable items into one or more groups of identifiers comprises, for each word string comprising auditable items:

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.

12. The method of claim 11, wherein the one or more rules comprises one or more specific item rules, one or more combination rules, or any combination thereof.

13. The method of claim 11, wherein the one or more predetermined items comprises one or more terms, one or more punctuation marks, or any combination thereof.

14. The method of claim 11, wherein automatically translating the one or more auditable items into one or more groups of identifiers comprises, for each word string comprising auditable items:

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.

15. The method of claim 11, wherein the multi-point estimate comprises an audit estimate based on each line item of the data file, wherein each line item is automatically evaluated based on any remaining line items of the data file.

16. The method of claim 11, wherein automatically translating the one or more auditable items into an operational item identifier comprises automatically translating an auditable item from the one or more auditable items that does not involve a physical removal of a vehicle part with a replacement of a replacement part in place of the removed vehicle part.

17. An apparatus comprising:

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

a make model translator in communication with the auditing system configured to automatically translate the make model information into a vehicle identifier;

an insurance company name translator in communication with the make model translator configured to automatically translate the insurance company information into an insurance company identifier;

a parts translator in communication with the insurance company name translator configured to automatically translate the one or more auditable items into one or more groups of identifiers, wherein the one or more groups of identifiers comprises one or more part item identifiers, one or more operational item identifiers, or both; and

an output unit in communication with the auditing apparatus configured to;

automatically generate a parts audit report based on the one or more groups of identifiers, the parts audit report comprising data indicative of whether one or more parts of the one or more auditable items is accepted based on one or more rules associated with the insurance company identifier;

automatically generate an operational audit report based on the one or more groups of identifiers, the operational audit report comprising data indicative of whether one or more operations of the one or more auditable items is accepted based on one or more rules associated with the insurance company identifier; and

automatically generate a multi-point estimate based on the parts audit report data and the operational audit report data.

18. 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 make model information, insurance company information, and one or more auditable items, each auditable item comprising a word string having one or more words;

automatically translate;

the make model information into a vehicle identifier;

the insurance company information into an insurance company identifier; and

the one or more auditable items into one or more groups of identifiers, wherein the one or more groups of identifiers comprises one or more part item identifiers, one or more operational item identifiers, or both;

automatically generate a parts audit report based on the one or more groups of identifiers, the parts audit report comprising data indicative of whether one or more parts of the one or more auditable items is accepted based on one or more rules associated with the insurance company identifier;

automatically generate an operational audit report based on the one or more groups of identifiers, the operational audit report comprising data indicative of whether one or more operations of the one or more auditable items is accepted based on one or more rules associated with the insurance company identifier; and

automatically generate a multi-point estimate based on the parts audit report data and the operational audit report data.

19. An apparatus comprising:

means for receiving a data file comprising make model information, insurance company information, and one or more auditable items, each auditable item comprising a word string having one or more words;

means for automatically translating the make model information into a vehicle identifier;

means for automatically translating the insurance company information into an insurance company identifier;

means for automatically translating the one or more auditable items into one or more groups of identifiers, wherein the one or more groups of identifiers comprises one or more part item identifiers, one or more operational item identifiers, or both; and

means for;

automatically generating a parts audit report based on the one or more groups of identifiers, the parts audit report comprising data indicative of whether one or more parts of the one or more auditable items is accepted based on one or more rules associated with the insurance company identifier;

automatically generating an operational audit report based on the one or more groups of identifiers, the operational audit report comprising data indicative of whether one or more operations of the one or more auditable items is accepted based on one or more rules associated with the insurance company identifier; and

automatically generating a multi-point estimate based on the parts audit report data and the operational audit report data.