Method, system and computer program code for automatically generating software for reformatting incoming data

• US 8,065,168 B2
• Filed: 04/25/2006
• Issued: 11/22/2011
• Est. Priority Date: 04/25/2006
• Status: Active Grant

• Current Assignee: Conduent Business Services, LLC (Conduent, Inc.)
• Original Assignee: ACS State & Local Solutions Incorporated (Conduent, Inc.)
• Inventors: Szlam, Aleksander
• Primary Examiner(s): Kyle; Charles
• Assistant Examiner(s): Niquette; Robert R
• Application Number:
  US11/412,001
• Publication Number:
  US 20070250351A1
• Time in Patent Office: 2,037 Days
• Field of Search: 705 35- 45, 705/4
• US Class Current: 705/4
• CPC Class Codes: G06Q 10/06 Resources, workflows, human or project management; Enterprise or organisation planning; Enterprise or organisation modelling
• CPC Class Codes: G06Q 10/087 Inventory or stock management, e.g. order filling, procurement or balancing against orders
• CPC Class Codes: G06Q 40/08 Insurance
• CPC Class Codes: Y10S 707/99933 Query processing, i.e. searching

Abstract

A method, system and computer program product are provided for creating software that can be used to reformat incoming insurance-related data into a format that conforms to the requirements or preferences of the receiving party. In particular, the software generated is capable of causing a particular action to be taken which will result in the transfer of the received data from one format to another in response to certain conditions being met. These conditions are defined by a decision table, from which the software is automatically generated. A means is further provided for using the received data, which has been reformatted where necessary, to create a user-friendly table that defines the rules and parameters of a particular insurance policy. The table is capable of being easily understood by those unfamiliar with the intricacies of insurance claim processing and programming code, and is further capable of being read by a claims processing engine when processing an insurance claim.

Claims

1. A method of creating software for reformatting insurance claim related data, said method comprising:

receiving definition data from one or more insurance providers, wherein the definition data defines one or more insurance policies offered by each of the one or more insurance providers, and wherein the format for at least one of the one or more insurance policies differs from a preferred format for the respective insurance policy;

creating a decision table based on a combination of conditions for when a respective one of a plurality of reformatting actions should be taken with respect to insurance claim related data received for the at least one of the one or more insurance policies, wherein the respective reformatting action reformats the insurance claim related data received for the at least one of the one or more insurance policies to the preferred format for the respective insurance policy;

providing the decision table to a software generator; and

automatically generating computer programming instructions based upon the decision table and configured to cause the respective reformatting action to be taken based on the combinations of conditions from the decision table upon execution thereof,

wherein each of the steps of the method is performed by a processor.

2. The method of claim 1, wherein a first party offers the one or more insurance policies to one or more third parties, and wherein a second party processes insurance claims submitted by the third parties under the insurance policies.

3. The method of claim 2, wherein the insurance claim related data comprises data relating to the one or more insurance providers authorized under a respective insurance policy offered by the first party.

4. The method of claim 2, wherein the insurance claim related data comprises data relating to one or more benefits under a respective insurance policy offered by the first party.

5. The method of claim 2, wherein the insurance claim related data comprises data relating to one or more eligibility requirements for a respective insurance policy offered by the first party.

6. The method of claim 1, wherein creating a decision table is repeated for each of the plurality of reformatting actions, such that a different decision table is created for each reformatting action based on a different combination of conditions defining when the reformatting action, with which the decision table is associated, should be taken.

7. The method of claim 6, wherein providing the decision table to the software generator is repeated for each of the different decision tables, such that for each of the different decision tables, a different set of computer programming instructions is automatically generated that causes the respective reformatting action, with which the decision table is associated, to be taken based on the combination of conditions from the decision table.

8. The method of claim 1, wherein the plurality of reformatting actions include moving one field of the insurance claim related data from one location to another location, translating the contents of one field, or looking up the contents of one field in a database.

9. The method of claim 1, further comprising:

receiving insurance claim related data corresponding to the one or more insurance policies; and

executing the computer programming instructions to reformat the insurance claim related data received for the at least one of the one or more insurance policies to the preferred format.

10. The method of claim 9, further comprising:

storing a correlation between the insurance claim related data received for the at least one of the one or more insurance policies to the reformatted data in the preferred format.

11. A system for creating software for reformatting insurance claim related data, said system comprising:

a software generator; and

a memory device comprising a decision table stored therein and accessible by the software generator, wherein definition data defines one or more insurance policies offered by each of one or more insurance providers, and wherein the format for at least one of the one or more insurance policies differs from a preferred format for the respective insurance policy, said decision table defining a combination of conditions that must occur for a respective one of a plurality of reformatting actions to be taken with respect to insurance claim related data received for the at least one of the one or more insurance policies, wherein the respective reformatting action reformats the insurance claim related data received for the at least one of the one or more insurance policies to the preferred format for the respective insurance policy, and

wherein the software generator automatically generates computer programming instructions based upon the decision table and configured to cause the respective reformatting action to be taken based on the combination of conditions from the decision table upon execution thereof.

12. The system of claim 11, wherein a second party processes one or more insurance policy claims received under the one or more insurance policies offered by a first party, and wherein said definition data assists the second party in processing the claims.

13. The system of claim 12, wherein the insurance claim related data comprises data relating to the one or more insurance providers authorized under a respective insurance policy offered by the first party.

14. The system of claim 12, wherein the insurance claim related data comprises data related to one or more benefits under a respective insurance policy offered by the first party.

15. The system of claim 12, wherein the insurance claim related data comprises data related to one or more eligibility requirements for a respective insurance policy offered by the first party.

16. The system of claim 11 further comprising a plurality of decision tables, wherein each of the plurality of decision tables defines a different combination of conditions that must be met in order for a respective one of the plurality of reformatting actions to be taken.

17. The system of claim 16, wherein for each of the plurality of decision tables, the software generator automatically generates a set of computer programming instructions that causes the respective reformatting action, with which the decision table is associated, to be taken based on the combination of conditions from the decision table.

18. A computer program product for reformatting insurance claim related data, wherein the computer program product comprises at least one computer-readable storage medium having computer-readable program code portions stored therein, the computer-readable program code portions comprising:

a first executable portion for receiving a decision table, wherein definition data defines one or more insurance policies offered by each of one or more insurance providers, and wherein the format for at least one of the one or more insurance policies differs from a preferred format for the respective insurance policy, said decision table defining a combination of conditions that must occur for a respective one of a plurality of reformatting actions to be taken with respect to insurance claim related data received for the at least one of the one or more insurance policies, wherein the respective reformatting action reformats the insurance claim related data received for the at least one of the one or more insurance policies to the preferred format for the respective insurance policy; and

a second executable portion for automatically generating computer programming instructions based upon the decision table and configured to cause the respective reformatting action to be taken based on the combination of conditions from the decision table upon execution thereof.

19. The computer program product of claim 18 further comprising:

a third executable portion for enabling a user to create the decision table.

20. The computer program product of claim 18, wherein a first party offers the one or more insurance policies to one or more third parties, and wherein a second party processes one or more insurance policy claims submitted by the third parties under the insurance policies.

21. The computer program product of claim 20, wherein the definition data assists the second party in processing the claims submitted.

22. The computer program product of claim 18, wherein receiving a decision table is repeated for each of the plurality of reformatting actions, such that a different decision table is received for each reformatting action based on a different combination of conditions defining when the reformatting action, with which the decision table is associated, should be taken.

23. The computer program product of claim 22, wherein automatically generating computer programming instructions based upon the decision table is repeated for each of the different decision tables, such that for each of the different decision tables, a different set of computer programming instructions is automatically generated that causes the respective reformatting action, with which the decision table is associated, to be taken based on the combination of conditions from the decision table.