Rule generation system adapted for an insurance claim processing system

• US 8,515,786 B2
• Filed: 02/22/2008
• Issued: 08/20/2013
• Est. Priority Date: 02/22/2008
• Status: Active Grant

• Current Assignee: DUCK Creek Technologies Incorporated
• Original Assignee: Accenture Global Services GmbH (Accenture PLC)
• Inventors: Goldfarb, Eugene
• Primary Examiner(s): Kyle, Charles
• Assistant Examiner(s): KANG, IRENE S
• Application Number:
  US12/036,115
• Publication Number:
  US 20090216803A1
• Time in Patent Office: 2,006 Days
• Field of Search: None
• US Class Current: 705/4
• CPC Class Codes: G06Q 40/08 Insurance

Abstract

A rule generation system facilitates the dynamic generation of rules for an insurance claim processing computer system. The rule generation system includes various modules and graphical user interfaces that provide a streamlined mechanism for creating new rules for the insurance claim processing architecture. The rule generation system may include various levels of usability that distinguish between an advanced user of the rule generation system and basic user that uses the generated rules. The rule generation system may also include graphical user interfaces directed to adding, editing, removing, or maintaining rules for the insurance claim processing computer system.

Claims

1. A rule generation system to generate rules for a computer program, the system comprising:

a processor;

a memory storage device comprising a computer program, the computer program comprising instructions executable with the processor, the instructions comprising;

an evaluative expression parameter module configured to generate a graphical user interface for creation of a navigation rule, the navigation rule being indicative of whether to navigate from a first page of the computer program to a second page of the computer program;

the evaluative expression parameter module further configured to receive an expression parameter, a logical operator, and at least one expression parameter value from the graphical user interface in response to user input via the graphical user interface at runtime, the expression parameter identifying a question displayed on the first page of the computer program, the at least one expression parameter value including at least one potential answer to the question, wherein the expression parameter and the at least one expression parameter value are operands of the logical operator;

an evaluative expression generator configured to generate the navigation rule, the navigation rule including a combination of a first evaluative expression and a second evaluative expression, the first evaluative expression comprising the expression parameter, the operator, and the at least one expression parameter value;

instructions executable with the processor to store the first and second evaluative expressions in a database;

instructions executable with the processor to receive an answer to the question displayed on the first page from user input at runtime;

instructions executable with the processor to evaluate the first and second evaluative expressions retrieved from the database at runtime, the expression parameter set to the answer in the evaluation of the first evaluative expression; and

instructions executable with the processor to navigate to the second page from the first page at runtime based on the evaluation of the first and second evaluative expressions retrieved from the database.

2. The rule generation system of claim 1, wherein the instructions further comprise a common evaluative expression module configured to receive names of common rules from the graphical user interface in response to user input, the evaluative expression generator further configured to include the names of the common rules as operands in the evaluative expression, the evaluation of the evaluative expression depending on an evaluation of the common rules.

3. The rule generation system of claim 1, wherein

the computer program further comprises instructions executable with the processor to navigate from the first page to the second page based on the evaluation of the first and second evaluative expressions of the navigation rule without a restart of the computer program between receipt of the second evaluative expression through the graphical user interface and the evaluation of the navigation rule.

4. The rule generation system of claim 1, wherein

the evaluative expression parameter module is further configured to generate a second graphical user interface that includes a name of the navigation rule selectable for inclusion in evaluative expressions of rules other than the navigation rule;

and

the evaluative expression parameter module is further configured to receive an expiration date for the navigation rule from the first graphical user interface in response to user input, and the expiration date indicates when the evaluative expression parameter module stops including the navigation rule in the second graphical user interface.

5. The rule generation system of claim 1, wherein the evaluative expression parameter module is further configured to modify the first and second evaluative expressions of the navigation rule based on expression parameters and expression parameter values received from the graphical user interface in response to user input at runtime.

6. The rule generation system of claim 1, wherein the evaluative expression parameter module is further configured to create a page display rule, the navigation rule, or a discrepancy rule depending on what evaluative expression category is received from the graphical user interface.

7. A computer-implemented method for generating rules for an application, the method comprising:

generating a graphical user interface with a processor for creation of a navigation rule, the navigation rule indicative of where to navigate when leaving a page in the application;

receiving an expression parameter, a logical operator, and at least one expression parameter value with the processor from the graphical user interface in response to user input entered through the graphical user interface, the expression parameter identifying a question, the at least one expression parameter value including at least one potential answer to the question, wherein the expression parameter and the at least one expression parameter value are operands of the logical operator;

generating the navigation rule with the processor, the navigation rule including a combination of a first evaluative expression and a second evaluative expression, the first evaluative expression comprising the expression parameter, the operator, and the at least one expression parameter value;

storing the first and second evaluative expressions in a database;

receiving an answer to the question with the processor from user input;

evaluating the first and second evaluative expressions retrieved from the database at runtime with the processor, the expression parameter set to the answer in the evaluation of the first evaluative expression; and

determining a next page with the processor when navigating away from the page based on the evaluation of the first and second evaluative expressions of the navigation rule.

8. The computer-implemented method of claim 7 further comprising:

receiving names of common rules from the graphical user interface in response to user input; and

including the names of the common rules as operands in the second evaluative expression, wherein evaluating the second evaluative expression further comprises evaluating the common rules.

9. The computer-implemented method of claim 7 further comprising:

generating the graphical user interface for creation of a page display rule, the page display rule indicative of whether to display an element on the page;

receiving a third evaluative expression from the graphical user interface in response to user input;

generating the page display rule comprising the third evaluative expression; and

determining whether to display the element on the page based on an evaluation of the page display rule without stopping the application after receiving the third evaluative expression.

10. The computer-implemented method of claim 7 further comprising receiving an expiration date for the navigation rule from the graphical user interface in response to user input, the expiration date indicative of when to stop displaying the navigation rule in the graphical user interface for inclusion in evaluative expressions of rules other than the navigation rule.

11. The computer-implemented method of claim 7 further comprising creating a discrepancy rule from a third evaluative expression received from the graphical user interface in response to user input, wherein the discrepancy rule indicates whether data discrepancies exist in answers provided to questions, and the answers are received by the application.

12. The computer-implemented method of claim 7 further comprising modifying the second evaluative expression in the navigation rule based on expression parameters and expression parameter values received from the graphical user interface in response to user input.

13. The computer-implemented method of claim 7 further comprising creating a page display rule, the navigation rule, or a discrepancy rule depending on what evaluative expression category is received from the graphical user interface in response to user input.

14. A non-transitory machine-readable medium comprising a software program for rule generation, the software program comprising instructions executable with a processor to:

generate a graphical user interface for creation of a navigation rule, the navigation rule indicative of where to navigate to when leaving a page of the software program;

receive a first expression parameter, a logical operator, and at least one expression parameter value entered through the graphical user interface in response to user input at runtime of the software program, the first expression parameter identifying a question, the at least one expression parameter value including at least one potential answer to the question, wherein the first expression parameter and the at least one expression parameter value are operands of the logical operator;

generate the navigation rule, the navigation rule comprising an evaluative expression comprising the first expression parameter, the operator, the at least one expression parameter value, and a second expression parameter;

store the evaluative expression in a database;

receive an answer to the question from user input at runtime of the software program;

evaluate the evaluative expression retrieved from the database at runtime of the software program, the first expression parameter set to the answer in the evaluation of the evaluative expression; and

navigate away from the page to a next page of the software program based on the evaluation of the evaluative expression of the navigation rule without a stop of the software program after the receipt of the first expression parameter, the logical operator, and the at least one expression parameter value from the graphical user interface.

15. The non-transitory machine-readable medium of claim 14, wherein the instructions are further configured to:

receive names of common rules from the graphical user interface in response to user input; and

include the names of the common rules as operands in the evaluative expression, and the evaluation of the evaluative expression depends on an evaluation of the common rules.

16. The non-transitory machine-readable medium of claim 14, wherein the instructions are further configured to:

generate a second graphical user interface that includes a name of a page display rule selectable for inclusion in evaluative expressions of rules other than the page display rule, the page display rule indicative of whether to display the question on the page; and

receive an expiration date for the page display rule from a third graphical user interface in response to user input, the expiration date indicative of when to stop including the name of the page display rule in the second graphical user interface.

17. The non-transitory machine-readable medium of claim 14, wherein the instructions are further configured to create a discrepancy rule from a second evaluative expression received from the graphical user interface in response to user input, wherein the discrepancy rule indicates whether data discrepancies exist in answers provided to questions.

18. The non-transitory machine-readable medium of claim 14, wherein the instructions are further configured to modify the evaluative expression of the navigation rule based on expression parameters and expression parameter values received from the graphical user interface in response to user input at runtime.

19. The non-transitory machine-readable medium of claim 14, wherein the instructions are further configured to create a page display rule, the navigation rule, or a discrepancy rule depending on an evaluative expression category received from the graphical user interface in response to user input.