WORKFLOW AUTOMATION ON POLICY UPDATES

• US 20200134060A1
• Filed: 10/29/2018
• Published: 04/30/2020
• Est. Priority Date: 10/29/2018
• Status: Active Grant

• Current Assignee: Ensemble RCM, LLC (Bon Secours Mercy Health, Inc.)
• Original Assignee: MHI Analytics, LLC
• Inventors: Schouten, Pieter, Miller, Ryan, Wilson, Michael, Hunter, John Bradford
• Granted Patent: US 11,232,092 B2
• Time in Patent Office: Days
• CPC Class Codes: G06F 16/21 Design, administration or maintenance of databases
• CPC Class Codes: G06F 16/2358 Change logging, detection, and notification replication G06F16/27
• CPC Class Codes: G06F 16/245 Query processing
• CPC Class Codes: G06F 16/285 Clustering or classification

Abstract

Embodiments of the present disclosure are directed to methods and systems for the timely processing of records exchanged between service provider systems and responsible entity systems by a records management and processing system. More specifically, the records management and processing system can maintain a set of rules defining conditions for processing records and associated actions to affect that processing upon satisfaction of or failure to satisfy the conditions of that rule. Updates to some or all of these records can be received from a data update service. The records management and processing system can apply the rules to the records and assign tags to the records based on the received update information and the conditions defined in the applied rules. The records management and processing system can then process the updated records according to workflows for processing the updated records based on the assigned tags and applied rules.

Claims

1. A method for implementing updates directed to the processing of database records, the method comprising:

maintaining, by a records management and processing system, a plurality of records in a database, each record of the plurality of records comprising a record of a service provided to a consumer by a service provider of a plurality of service providers and identifying at least one required action by at least one responsible entity of a plurality of responsible entities and wherein the records management and processing system comprises an intermediary between systems of the plurality of service providers and systems of the plurality of responsible entities;

processing, by the records management and processing system, the plurality of records according to one or more workflows executed by the records management and processing system, wherein the one or more workflows process the plurality of records based on one or more rules applied to the plurality of records;

receiving, by the records management and processing system from a data update service, a set of update information directed to the processing of the plurality of records, wherein the update information is collected by the data update service from the systems of the plurality of responsible entities;

parsing, by the records management and processing system, the received set of update information into one or more sets of instructions related to processing of one or more records of the plurality of records;

assigning, by the records management and processing system, each of the one or more sets of instructions to one or more categories of a plurality of pre-defined categories of resources, each of the plurality of pre-defined categories of resources comprising one or more resources of the records management and processing system performing processing on the plurality of workflows according to the one or more workflows; and

forwarding, by the records management and processing system, the one or more sets of instructions to each of the one or more resources in the one or more categories to which the sets of instructions have been assigned.

2. The method of claim 1, further comprising monitoring, by the records management and processing system, processing of the plurality of records according to the one or more workflows and the one or more sets of instructions.

3. The method of claim 2, further comprising tracking, by the records management and processing system, results of processing the plurality of records according to the one or more workflows and the one or more sets of instructions, the results indicating whether the one or more sets of instructions were applied in the processing of the plurality of records.

4. The method of claim 3, further comprising analyzing, by the records management and processing system, the results of processing the plurality of records according to the one or more workflows and the one or more sets of instructions.

5. The method of claim 4, further comprising, implementing, by the records management and processing system, changes to the one or more workflows or the rules applied to the plurality of records based on analyzing the results of processing the plurality of records according to the one or more workflows and the one or more sets of instructions.

6. The method of claim 4, further comprising, implementing, by the records management and processing system, changes to the plurality of pre-defined categories of resources or one or more resources of at least one of the pre-defined categories of resources based on analyzing the results of processing the plurality of records according to the one or more workflows and the one or more sets of instructions.

7. The method of claim 4, further comprising, predicting, by the records management and processing system, one or more action to perform in addition to the one or more workflows and rules to implement the updates.

8. A system comprising:

a processor; and

a memory coupled with and readable by the processor and storing therein a set of instructions which, when executed by the processor, causes the processor to implement updates directed to the processing of database records by;

maintaining a plurality of records in a database, each record of the plurality of records comprising a record of a service provided to a consumer by a service provider of a plurality of service providers and identifying at least one required action by at least one responsible entity of a plurality of responsible entities and wherein the records management and processing system comprises an intermediary between systems of the plurality of service providers and systems of the plurality of responsible entities;

processing the plurality of records according to one or more workflows executed by the records management and processing system, wherein the one or more workflows process the plurality of records based on one or more rules applied to the plurality of records;

receiving, from a data update service, a set of update information directed to the processing of the plurality of records, wherein the update information is collected by the data update service from the systems of the plurality of responsible entities;

parsing the received set of update information into one or more sets of instructions related to processing of one or more records of the plurality of records;

assigning each of the one or more sets of instructions to one or more categories of a plurality of pre-defined categories of resources, each of the plurality of pre-defined categories of resources comprising one or more resources of the records management and processing system performing processing on the plurality of workflows according to the one or more workflows; and

forwarding the one or more sets of instructions to each of the one or more resources in the one or more categories to which the sets of instructions have been assigned.

9. The system of claim 8, wherein the instructions further cause the processor to monitoring, by the records management and processing system, processing of the plurality of records according to the one or more workflows and the one or more sets of instructions.

10. The system of claim 9, wherein the instructions further cause the processor to track results of processing the plurality of records according to the one or more workflows and the one or more sets of instructions, the results indicating whether the one or more sets of instructions were applied in the processing of the plurality of records.

11. The system of claim 10, wherein the instructions further cause the processor to analyze the results of processing the plurality of records according to the one or more workflows and the one or more sets of instructions.

12. The system of claim 11, wherein the instructions further cause the processor to implement changes to the one or more workflows or the rules applied to the plurality of records based on analyzing the results of processing the plurality of records according to the one or more workflows and the one or more sets of instructions.

13. The system of claim 11, wherein the instructions further cause the processor to implement changes to the plurality of pre-defined categories of resources or one or more resources of at least one of the pre-defined categories of resources based on analyzing the results of processing the plurality of records according to the one or more workflows and the one or more sets of instructions.

14. The system of claim 11, wherein the instructions further cause the processor to predict one or more action to perform in addition to the one or more workflows and rules to implement the updates.

15. A non-transitory, computer-readable medium comprising a set of instructions stored therein which, when executed by a processor, causes the processor to implementing updates directed to the processing of database records by:

maintaining, by a records management and processing system, a plurality of records in a database, each record of the plurality of records comprising a record of a service provided to a consumer by a service provider of a plurality of service providers and identifying at least one required action by at least one responsible entity of a plurality of responsible entities and wherein the records management and processing system comprises an intermediary between systems of the plurality of service providers and systems of the plurality of responsible entities;

processing, by the records management and processing system, the plurality of records according to one or more workflows executed by the records management and processing system, wherein the one or more workflows process the plurality of records based on one or more rules applied to the plurality of records;

receiving, by the records management and processing system from a data update service, a set of update information directed to the processing of the plurality of records, wherein the update information is collected by the data update service from the systems of the plurality of responsible entities;

parsing, by the records management and processing system, the received set of update information into one or more sets of instructions related to processing of one or more records of the plurality of records;

assigning, by the records management and processing system, each of the one or more sets of instructions to one or more categories of a plurality of pre-defined categories of resources, each of the plurality of pre-defined categories of resources comprising one or more resources of the records management and processing system performing processing on the plurality of workflows according to the one or more workflows; and

forwarding, by the records management and processing system, the one or more sets of instructions to each of the one or more resources in the one or more categories to which the sets of instructions have been assigned.

16. The non-transitory, computer-readable medium of claim 15, wherein the instructions further cause the processor to monitoring, by the records management and processing system, processing of the plurality of records according to the one or more workflows and the one or more sets of instructions.

17. The non-transitory, computer-readable medium of claim 16, wherein the instructions further cause the processor to track results of processing the plurality of records according to the one or more workflows and the one or more sets of instructions, the results indicating whether the one or more sets of instructions were applied in the processing of the plurality of records.

18. The non-transitory, computer-readable medium of claim 17, wherein the instructions further cause the processor to analyze the results of processing the plurality of records according to the one or more workflows and the one or more sets of instructions.

19. The non-transitory, computer-readable medium of claim 18, wherein the instructions further cause the processor to implement changes to the one or more workflows, the rules applied to the plurality of records, the plurality of pre-defined categories of resources, or one or more resources of at least one of the pre-defined categories of resources based on analyzing the results of processing the plurality of records according to the one or more workflows and the one or more sets of instructions.

20. The non-transitory, computer-readable medium of claim 18, wherein the instructions further cause the processor to predict one or more action to perform in addition to the one or more workflows and rules to implement the updates.