Claims processing of information requirements
First Claim
Patent Images
1. A method of processing claims relating to a policy, comprising:
- a computer system receiving at least one notice of an event or a condition that gives rise to a claim for payment under a first policy;
the computer system creating a claim management case in response to the at least one notice of the event or condition that gives rise to the claim for payment under the first policy, wherein creating the claim management case comprises associating one or more policies with the claim management case and associating one or more coverages with one of the policies;
the computer system creating a node hierarchy for processing claims, wherein creating the node hierarchy comprises;
the computer system creating, at a claim management case level, a claim management case node;
the computer system creating, at a policy level separate from and below the claim management case level, one or more policy nodes, wherein each of at least one of the policy nodes is associated with one of the policies,the computer system creating, at a coverage level separate from and below the policy level, one or more coverage nodes, wherein each of at least one of the coverage nodes is associated with a base coverage or a rider under at least one of the policies associated with one of the policy nodes,the computer system creating, at a designee level, one or more designee nodes, wherein at least one of the designee nodes is associated with a designee on at least one of the policies or on at least one of the base coverages or riders; and
the computer system attaching at least one of the designee nodes of the designee level to at least one of the policy nodes of the policy level or at least one of the coverage nodes of the coverage level, wherein the level of the node to which the at least one designee node is attached by the computer system depends on whether the designee node corresponds to one of the policies as a whole or pertains to a particular base coverage or a particular rider under a policy, wherein the at least one designee node is attached to a policy node of the policy level if the at least one designee node pertains to one of the policies as a whole, wherein the at least one designee node is attached to a coverage node of the coverage level if the designee node pertains to a particular one of the base coverages or to a particular one of the riders;
the computer system performing, at the claim management case level, using the claim management case node, at least one process to fulfill an information requirement for adjudicating the policies;
the computer system performing, at the policy level, using at least one of the policy nodes, one or more processes to fulfill an information requirement for adjudicating an policy associated with the claim management case, wherein the at least one of the one or more processes performed at the policy level applies to only one of the policies associated with the claim management case;
the computer system performing, at the coverage level, using at least one of the coverage nodes, one or more processes to fulfill an information requirement for a coverage associated with the claim management case, wherein the at least one of the one or more processes performed at the coverage level applies to only one of the coverages associated with one of the policies;
the computer system determining whether predetermined information requirements for the claim management case have been met at the case management level, the policy level, and the coverage level;
the computer system inhibiting adjudication of any the policies in the claim management case or adjudication of any of the coverages in the claim management case until the predetermined information requirements for the claim management case are satisfied at the case management level, the policy level, and the coverage level;
the computer system performing at least one rendezvous, wherein at least one rendezvous comprises;
a queued item waiting for a response from a policy administration system;
the queued item receiving response data from the policy administration system;
the computer system comparing the response data from the policy administration system to expected data; and
the computer system determining that a rendezvous is effective based on a match of the response data and the expected data; and
adjudicating at least one claim under one or more of the policies.
1 Assignment
0 Petitions
Accused Products
Abstract
Methods and systems are provided for processing claims. A claim management case is created for an insured in response to a notice of a claim. One or more insurance policies covering the insured are associated with the claim management case. At least one process is performed at a claim management case level to fulfill an information requirement that applies to at least two of the insurance policies associated with the claim management case. Claims are adjudicated under the one or more of the insurance policies covering the insured.
251 Citations
17 Claims
-
1. A method of processing claims relating to a policy, comprising:
-
a computer system receiving at least one notice of an event or a condition that gives rise to a claim for payment under a first policy; the computer system creating a claim management case in response to the at least one notice of the event or condition that gives rise to the claim for payment under the first policy, wherein creating the claim management case comprises associating one or more policies with the claim management case and associating one or more coverages with one of the policies; the computer system creating a node hierarchy for processing claims, wherein creating the node hierarchy comprises; the computer system creating, at a claim management case level, a claim management case node; the computer system creating, at a policy level separate from and below the claim management case level, one or more policy nodes, wherein each of at least one of the policy nodes is associated with one of the policies, the computer system creating, at a coverage level separate from and below the policy level, one or more coverage nodes, wherein each of at least one of the coverage nodes is associated with a base coverage or a rider under at least one of the policies associated with one of the policy nodes, the computer system creating, at a designee level, one or more designee nodes, wherein at least one of the designee nodes is associated with a designee on at least one of the policies or on at least one of the base coverages or riders; and the computer system attaching at least one of the designee nodes of the designee level to at least one of the policy nodes of the policy level or at least one of the coverage nodes of the coverage level, wherein the level of the node to which the at least one designee node is attached by the computer system depends on whether the designee node corresponds to one of the policies as a whole or pertains to a particular base coverage or a particular rider under a policy, wherein the at least one designee node is attached to a policy node of the policy level if the at least one designee node pertains to one of the policies as a whole, wherein the at least one designee node is attached to a coverage node of the coverage level if the designee node pertains to a particular one of the base coverages or to a particular one of the riders; the computer system performing, at the claim management case level, using the claim management case node, at least one process to fulfill an information requirement for adjudicating the policies; the computer system performing, at the policy level, using at least one of the policy nodes, one or more processes to fulfill an information requirement for adjudicating an policy associated with the claim management case, wherein the at least one of the one or more processes performed at the policy level applies to only one of the policies associated with the claim management case; the computer system performing, at the coverage level, using at least one of the coverage nodes, one or more processes to fulfill an information requirement for a coverage associated with the claim management case, wherein the at least one of the one or more processes performed at the coverage level applies to only one of the coverages associated with one of the policies; the computer system determining whether predetermined information requirements for the claim management case have been met at the case management level, the policy level, and the coverage level; the computer system inhibiting adjudication of any the policies in the claim management case or adjudication of any of the coverages in the claim management case until the predetermined information requirements for the claim management case are satisfied at the case management level, the policy level, and the coverage level; the computer system performing at least one rendezvous, wherein at least one rendezvous comprises; a queued item waiting for a response from a policy administration system; the queued item receiving response data from the policy administration system; the computer system comparing the response data from the policy administration system to expected data; and the computer system determining that a rendezvous is effective based on a match of the response data and the expected data; and adjudicating at least one claim under one or more of the policies. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 13, 14, 15, 16, 17)
-
-
11. A system, comprising:
-
a processor; a memory coupled to the processor and configured to store program instructions executable by the processor to; receiving at least one notice of an event or a condition that gives rise to a claim for payment under a first policy; creating a claim management case in response to the at least one notice of the event or condition that gives rise to the claim for payment under the first policy, wherein creating the claim management case comprises associating one or more policies with the claim management case and associating one or more coverages with one of the policies; creating a node hierarchy for processing claims, wherein creating the node hierarchy comprises; creating, at a claim management case level, a claim management case node; creating, at a policy level separate from and below the claim management case level, one or more policy nodes, wherein each of at least one of the policy nodes is associated with one of the policies, creating, at a coverage level separate from and below the policy level, one or more coverage nodes, wherein each of at least one of the coverage nodes is associated with a base coverage or rider under at least one of the policies associated with one of the policy nodes, creating, at a designee level, one or more designee nodes, wherein at least one of the designee nodes is associated with a designee on at least one of the policies or on at least one of the base coverages or riders; and attaching at least one of the designee nodes of the designee level to at least one of the policy nodes of the policy level or at least one of the coverage nodes of the coverage level, wherein the level of the node to which the at least one designee node is attached depends on whether the designee node corresponds to one of the policies as a whole or pertains to a particular base coverage or a particular rider under a policy, wherein the at least one designee node is attached to a policy node of the policy level if the at least one designee node pertains to one of the policies as a whole, wherein the at least one designee node is attached to a coverage node of the coverage level if the designee node pertains to a particular one of the base coverages or to a particular one of the riders; performing, at the claim management case level, using the claim management case node, at least one process to fulfill an information requirement for adjudicating the policies; performing, at the policy level, using at least one of the policy nodes, one or more processes to fulfill an information requirement for adjudicating a policy associated with the claim management case, wherein the at least one of the one or more processes performed at the policy level applies to only one of the policies associated with the claim management case; performing, at the coverage level, using at least one of the coverage nodes, one or more processes to fulfill an information requirement for a coverage associated with the claim management case, wherein the at least one of the one or more processes performed at the coverage level applies to only one of the coverages associated with one of the policies; determining whether predetermined information requirements for the claim management case have been met at the case management level, the policy level, and the coverage level; inhibiting adjudication of any the policies in the claim management case or adjudication of any of the coverages in the claim management case until the predetermined information requirements for the claim management case are satisfied at the case management level, the policy level, and the coverage level; the computer system performing at least one rendezvous, wherein at least one rendezvous comprises; a queued item waiting for a response from a policy administration system; the queued item receiving response data from the policy administration system; the computer system comparing the response data from the policy administration system to expected data; and the computer system determining that a rendezvous is effective based on a match of the response data and the expected data; and adjudicating at least one claim under one or more of the policies.
-
-
12. A tangible, computer readable physical storage medium comprising program instructions stored thereon, wherein the program instructions are computer-executable to:
-
receiving at least one notice of an event or a condition that gives rise to a claim for payment under a first policy; creating a claim management case for the insured in response to the at least one notice of the event or condition that gives rise to the claim for payment under the first policy, wherein creating the claim management case comprises associating one or more policies with the claim management case and associating one or more coverages with one of the policies; creating a node hierarchy for processing claims, wherein creating the node hierarchy comprises; creating, at a claim management case level, a claim management case node; creating, at a policy level separate from and below the policy level, one or more policy nodes, wherein each of at least one of the policy nodes is associated with one of the policies, creating, at a coverage level separate from and below the policy level, one or more coverage nodes, wherein each of at least one of the coverage nodes is associated with a base coverage or rider under at least one of the policies associated with one of the policy nodes, creating, at a designee level, one or more designee nodes, wherein at least one of the designee nodes is associated with a designee on at least one of the policies or on at least one of the base coverages or riders; and attaching at least one of the designee nodes of the designee level to at least one of the policy nodes of the policy level or at least one of the coverage nodes of the coverage level, wherein the level of the node to which the at least one designee node is attached depends on whether the designee node corresponds to one of the policies as a whole or pertains to a particular base coverage or a particular rider under a policy, wherein the at least one designee node is attached to a policy node of the policy level if the at least one designee pertains to one of the policies as a whole, wherein the at least one designee is attached to a coverage node of the coverage level if the designee node pertains to a particular one of the base coverages or to a particular one of the riders; performing, at the claim management case level, using the claim management case node, at least one process to fulfill an information requirement for adjudicating the policies, wherein the information requirement applies to at least one of the policies associated with the claim management case; performing, at the policy level, using at least one of the policy nodes, one or more processes to fulfill an information requirement for adjudicating an policy associated with the claim management case, wherein the at least one of the one or more processes performed at the policy level applies to only one of the policies associated with the claim management case; performing, at the coverage level, using at least one of the coverage nodes, one or more processes to fulfill an information requirement for a coverage associated with the claim management case, wherein the at least one of the one or more processes performed at the coverage level applies to only one of the coverages associated with one of the insurance policies; determining whether predetermined information requirements for the claim management case have been met at the case management level, the policy level, and the coverage level; inhibiting adjudication of any the policies in the claim management case or adjudication of any of the coverages in the claim management case until the predetermined information requirements for the claim management case are satisfied at the case management level, the policy level, and the coverage level; the computer system performing at least one rendezvous, wherein at least one rendezvous comprises; a queued item waiting for a response from a policy administration system; the queued item receiving response data from the policy administration system; the computer system comparing the response data from the policy administration system to expected data; and the computer system determining that a rendezvous is effective based on a match of the response data and the expected data; and adjudicating at least one claim under one or more of the policies.
-
Specification