Automation of auditing claims

• US 8,600,782 B2
• Filed: 09/04/2012
• Issued: 12/03/2013
• Est. Priority Date: 05/29/2009
• Status: Active Grant

• Current Assignee: HyperQuest, Inc. (Solera Holdings Incorporated)
• Original Assignee: HyperQuest, Inc. (Solera Holdings Incorporated)
• Inventors: Hogan, Dennis M., Hogan, Jeffrey J.
• Primary Examiner(s): Tran, Hai
• Application Number:
  US13/602,980
• Publication Number:
  US 20130006605A1
• Time in Patent Office: 455 Days
• Field of Search: 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 10/10 Office automation; Time management
• CPC Class Codes: G06Q 20/102 Bill distribution or payments
• CPC Class Codes: G06Q 30/0222 During e-commerce, i.e. online transactions
• CPC Class Codes: G06Q 40/00 Finance; Insurance; Tax strategies; Processing of corporate or income taxes
• CPC Class Codes: G06Q 40/08 Insurance

Abstract

Described are computer-based methods and apparatuses, including computer program products, for automation of auditing claims. A data file is received comprising one or more auditable items, each auditable item comprising a word string having one or more words. Each word string for each auditable item is translated using one or more translation steps into a translated item description. Each translated item description is compared to a plurality of terms to generate matching information. Each translated item description is associated with an item identifier based on the matching information. Each auditable item is accepted or rejected based on the item identifier and one or more rules associated with the data file.

Claims

1. A computerized auditing method comprising:

receiving, via a processor, a data file comprising one or more auditable items;

extracting, using the processor, a word string from each auditable item;

translating, using the processor, each word string using one or more translation steps into a translated item description;

for each translated item description;

comparing, using the processor, the translated item description to a plurality of terms;

generating, using the processor, a matching table comprising one or more entries, wherein each entry of the matching table comprises a matching term from the plurality of terms and matching information, the matching information comprising a match characteristic between the translated item description and the term and an item identifier;

determining, using the processor, whether the match characteristic for each entry is below a predetermined threshold;

if the match characteristic, is below the predetermined threshold, removing, using the processor, the entry from the matching table;

determining, using the processor, if one entry of the matching table comprises a best match;

if one entry comprises the best match, associating, using the processor, the item identifier of the one entry with the translated item description;

if no entry comprises the be match;

determining, using the processor, whether a plurality of entries comprise a similar match indicator value;

if the plurality of entries comprise the similar match indicator value, associating, using the processor, the item identifier for each of the plurality of entries with the translated item description, otherwise associating the translated item description with a no match indicator;

accepting, using the processor, or rejecting each auditable item associated with an item identifier based on the item identifier and one or more rules associated with the data file; and

generating, using the processor, an audit report.