Method of and system for rules-based population of a knowledge base used for medical claims processing

• US 7,386,526 B1
• Filed: 10/21/2003
• Issued: 06/10/2008
• Est. Priority Date: 05/16/2001
• Status: Expired due to Fees

• Current Assignee: NTT Data Services Corporation
• Original Assignee: Perot Systems Corporation (Dell Technologies Inc.)
• Inventors: Chappel, Oscar A.
• Primary Examiner(s): Vincent; David
• Assistant Examiner(s): BUSS, BENJAMIN J
• Application Number:
  US10/690,257
• Time in Patent Office: 1,694 Days
• Field of Search: 706 45- 47, 705/2, 705/4, 705/35, 705/40, 707 3- 4, 707100-102, 707/104.1, 707/513, 707/523, 707/530, 707/531, 709/246
• US Class Current: 706/47
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 30/0202 Market predictions or forecasting for commercial activities

Abstract

A method of populating a knowledge base used in validating medical claims includes filtering a translated edit via at least one rule to determine a match between a syntax of the translated edit and a syntax of the rule. A method call is executed responsive to the filtering step resulting in at least one match being determined. The knowledge base is populated responsive to the executing step.

Claims

1. A method of populating a knowledge base, the method comprising:

filtering a translated edit via at least one knowledge-base-population rule to determine a match between a syntax of the translated edit and a syntax of the knowledge-base-population rule;

executing a method call responsive to the filtering step resulting in at least one match being determined;

populating the knowledge base with facts and rules derived from the translated edit in accordance with the at least one knowledge-base-population rule responsive to the executing step;

wherein the knowledge base comprises a collection of facts and rules usable for medical claim processing;

wherein the at least one knowledge-base-population rule represents a pattern, the pattern being a combination of variables and constants in a specified order;

wherein an edit represents a directive to correct or reject a medical claim that does not comply with business rules; and

wherein the translated edit represents at least a portion of the edit in a syntactical form for filtering by the at least one knowledge base population rule.

2. The method of claim 1, further comprising translating the edit to yield the translated edit.

3. The method according to claim 1, further comprising binding at least one variable from the at least one knowledge-base-population rule responsive to the filtering step.

4. The method according to claim 3, wherein the executing step comprises:

expanding the at least one variable; and

creating an instance of a code object corresponding to the called method.

5. The method according to claim 1, further comprising validating the medical claim using the populated knowledge base.

6. The method according to claim 4, wherein the step of populating the knowledge base comprises adding information contained in the created code-object instances to the knowledge base.

7. The method of claim 1 or 2, further comprising the step of verifying that the edit has been correctly translated.

8. An article of manufacture for populating a knowledge base used in validating medical claims, the article of manufacture comprising:

at least one computer readable medium;

processor instructions contained on the at least one computer readable medium, the processor instructions configured to be readable from the at least one computer readable medium by at least one processor and thereby cause the at least one processor to operate as to;

filter a translated edit via at least one knowledge-base-population rule to determine a match between the translated edit and the knowledge-base-population rule;

execute a method call responsive to the translated edit having been filtered and a determination of at least one match;

populate the knowledge base responsive to the execution of the method call with facts and rules derived from the translated edit in accordance with the at least one knowledge-base-population rule;

wherein the knowledge base comprises a collection of facts and rules usable for medical claim processing; and

wherein the at least one knowledge-base-population rule represents a pattern, the pattern being a combination of variables and constants in a specified order;

wherein an edit represents a directive to correct or reject a medical claim that does not comply with business rules; and

wherein the translated edit represents at least a portion of the edit in a syntactical form for filtering by at least one knowledge base population rule.

9. The article of manufacture of claim 8, further comprising processor instructions configured to cause the at least one processor to operate as to translate the edit to yield the translated edit and create an edit-object instance.

10. The article of manufacture of claim 8, further comprising processor instructions configured to cause the at least one processor to operate as to bind at least one variable from the at least one knowledge-base-population rule responsive to the translated edit having been filtered.

11. The article of manufacture of claim 10, wherein the execution of the method call comprises:

expanding the at least one variable; and

creating an instance of a code object corresponding to the called method.

12. The article of manufacture of claim 8, further comprising processor instructions configured to cause the at least one processor to operate as to validate the medical claim using the populated knowledge base.

13. The article of manufacture of claim 11, wherein the population of the knowledge base comprises adding information contained in a created edit-object instance and the created code-object instances to the knowledge base.

14. The article of manufacture of claim 8 or 9, further comprising processor instructions configured to cause the at least one processor to operate as to verify whether the edit has been correctly translated.

15. A system for populating a knowledge base, the system comprising:

means for filtering a translated edit via at least one knowledge-base-population rule to determine a match between a syntax of the translated edit and a syntax of the knowledge-base-population rule;

means for executing a method call responsive to the filtering having resulting in at least one match having been determined;

means for populating the knowledge base responsive to an output of the means for executing with facts and rules derived from the translated edit in accordance with the at least one knowledge-base-population rule;

means for storing the knowledge base, wherein the knowledge base comprises a collection of facts and rules usable for medical claim processing;

wherein the at least one knowledge-base-population rule represents a pattern, the pattern being a combination of variables and constants in a specified order;

wherein an edit represents a directive to correct or reject a medical claim that does not comply with business rules; and

wherein the translated edit represents at least a portion of the edit in a syntactical form for filtering by the at least one knowledge base population rule.

16. The system of claim 15, further comprising means for translating the edit to yield the translated edit.

17. The system according to claim 15, further comprising means for binding at least one variable from the at least one knowledge-base-population rule responsive to the filtering.

18. The system according to claim 17, wherein the means for executing comprises:

means for expanding the at least one variable; and

means for creating an instance of a code object corresponding to the called method.

19. The system according to claim 15, further comprising means for validating the medical claim using the populated knowledge base.

20. The system according to claim 18, wherein the means for populating the knowledge base comprises means for adding information contained in the created code-object instances to the knowledge base.

21. The system of claim 15 or 16, further comprising means for verifying that the edit has been correctly translated.