Method of and system for populating knowledge bases using rule based systems and object-oriented software

• US 7,822,621 B1
• Filed: 10/21/2003
• Issued: 10/26/2010
• 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): LE, LINH GIANG
• Application Number:
  US10/690,258
• Time in Patent Office: 2,562 Days
• Field of Search: 705 2- 4, 704/9, 706/45, 707/3
• US Class Current: 705/2
• CPC Class Codes: G06Q 10/087 Inventory or stock management, e.g. order filling, procurement or balancing against orders
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 40/08 Insurance

Abstract

A method of populating a knowledge base used in validating medical claims includes creating and/or editing at least one claim element 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 created or edited claim element 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:

creating at least one claim element based on information related to a field from a claim form for an insurance provider, the at least one claim element comprising a reference claim element;

wherein the at least one claim element comprises at least one edit deduced from the information related to the field from the claim form, an edit comprising a directive of an insurance provider to correct or reject an insurance claim under specified circumstances;

applying at least one knowledge-base-population rule to the at least one edit to form claim-processing knowledge for the at least one claim element;

wherein the application comprises determining a match between a pattern of the at least one edit and a pattern of the at least one knowledge-base-population rule;

wherein the claim-processing knowledge comprises one or more conclusions specified by the at least one knowledge-base-population rule based on the determined match;

populating the knowledge base with said claim-processing knowledge acquired from said application, the knowledge base being resident in a computer-readable storage medium in a computing system;

wherein the population comprises at least one of creating and updating an instance of the at least one claim element with the claim-processing knowledge; and

wherein the creating, the performing, and the populating are performed via at least one computer in the computing system comprising a processor and memory.

2. The method of claim 1, further comprising translating an edit to yield a translated edit, the translated edit being utilized in the step of creating the at least one claim element, the at least one edit comprising the translated edit.

3. The method according to claim 1, further comprising binding at least one conclusion variable of the at least one knowledge-base-population rule responsive to the application of the at least one knowledge-base-population rule.

4. The method according to claim 3, wherein the creation of the at least one claim element comprises:

creating at least one attribute; and

assigning at least one value to said at least one attribute.

5. The method according to claim 1, further comprising validating a claim using appropriate claim-element knowledge in the populated knowledge base.

6. The method according to claim 1, wherein the creation of the at least one claim element comprises:

creating at least one reported claim element.

7. The method according to claim 6, further comprising validating a claim by comparing said at least one reported claim element to said at least one claim element.

8. The method according to claim 2, further comprising verifying that the translated edit has been correctly translated.

15. The method of claim 1, wherein the at least one claim element includes a plurality of edits, the plurality of edits representing situations that hinder claim payment by a payer.

16. The method of claim 15, wherein the applying step comprises applying the at least one knowledge-base-population rule to at least one of the plurality of edits to acquire the claim-processing knowledge.

17. The method of claim 15, wherein the plurality of edits comprises a plurality of translated edits, wherein at least one translated edit in the plurality of translated edits represents at least a portion of an edit in a syntactical form that facilitates application of a knowledge-base-population rule applied thereto.

9. 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 included 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;

create at least one claim element based on information related to a field from a claim form for an insurance provider, the at least one claim element comprising a reference claim element;

wherein the at least one claim element comprises at least one edit deduced from the information related to the field from the claim form, an edit comprising a directive of an insurance provider to correct or reject an insurance claim under specified circumstances;

apply at least one knowledge-base-population rule to the at least one edit to form claim-processing knowledge for the at least one claim element;

wherein the application comprises a determination of a match between a pattern of the at least one edit and a pattern of the at least one knowledge-base-population rule;

wherein the claim-processing knowledge comprises one or more conclusions specified by the at least one knowledge-base-population rule based on the determined match;

populate the knowledge base with said claim-processing knowledge acquired from said application; and

wherein the population comprises at least one of creating and updating an instance of the at least one claim element with the claim-processing knowledge.

10. The article of manufacture of claim 9, further comprising processor instructions configured to cause the at least one processor to operate as to translate an edit to yield a translated edit, the translated edit being utilized in the step of creating the at least one claim element, the at least one edit comprising the translated edit.

11. The article of manufacture of claim 9, further comprising processor instructions configured to cause the at least one processor to operate as to create at least one attribute and to assign at least one value to said at least one attribute.

12. The article of manufacture of claim 9, wherein the creation of the at least one claim element comprises:

creating at least one reported claim element.

13. The article of manufacture of claim 9, further comprising processor instructions configured to cause the at least one processor to operate as to validate a claim using appropriate claim-element knowledge in the populated knowledge base.

14. The article of manufacture of claim 10, further comprising processor instructions configured to cause the at least one processor to operate as to verify whether the translated edit has been correctly translated.

18. The article of manufacture of claim 11, wherein the at least one claim element includes a plurality of edits, the plurality of edits representing situations that hinder claim payment by a payer.

19. The article of manufacture of claim 18, wherein the application of the knowledge-base-population rule comprises application of the at least one knowledge-base-population rule to at least one of the plurality of edits to acquire the claim-processing knowledge.

20. The article of manufacture of claim 18, wherein the plurality of edits comprises a plurality of translated edits, wherein at least one translated edit in the plurality of translated edits represents at least a portion of an edit in a syntactical form that facilitates application of a knowledge-base-population rule applied thereto.

21. A method comprising:

creating a plurality of claim elements based on a plurality of fields from a plurality of claim forms, the plurality of claim elements comprising a plurality of edits, the plurality of edits representing one or more situations that hinder claim payment by a payer;

for each of the plurality of claim elements, applying one or more knowledge-base-population rules for a knowledge base to at least some of the plurality of edits to form claim-processing knowledge for the plurality of claim elements; and

populating the knowledge base with the claim-processing knowledge acquired from the applying step, the knowledge base being resident in a computer-readable storage medium in a computing system;

wherein the creating, the performing, and the populating are performed via at least one computer in the computing system comprising a processor and memory.

22. The method of claim 21, wherein the plurality of edits comprises a plurality of translated edits, wherein at least one translated edit in the plurality of translated edits represents at least a portion of an edit in a syntactical form that facilitates application of a knowledge-base-population rule applied thereto.