System and method for using a first electronic representation of contract terms for generating a second electronic representation of the contract terms

• US 8,768,729 B2
• Filed: 10/14/2004
• Issued: 07/01/2014
• Est. Priority Date: 10/14/2004
• Status: Active Grant

• Current Assignee: Cognizant Trizetto Software Group Incorporated (Cognizant Technology Solutions Corp.)
• Original Assignee: TriZetto Corporation (Cognizant Technology Solutions Corp.)
• Inventors: Hoerle, Dale E., Hensley, Jeffery K.
• Primary Examiner(s): Akintola, Olabode
• Application Number:
  US10/965,673
• Publication Number:
  US 20060085311A1
• Time in Patent Office: 3,547 Days
• Field of Search: None
• US Class Current: 705/4
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 40/00 Finance; Insurance; Tax strategies; Processing of corporate or income taxes
• CPC Class Codes: G06Q 40/08 Insurance

Abstract

Systems and methods are provided in which contract terms from a first electronic representation of a contract are used to form at least a part of a second electronic representation of the contract. For instance, the first electronic representation of a contract may be formed for use with a first software application, such as an adjudication application, and such first electronic representation of the contract is used by a system to form at least part of a second electronic representation of the contract, wherein such second electronic representation is used by a second software application, such as a contract management application. Disparate applications often utilize different representations of contract terms, and certain embodiments enable a second electronic representation to be formed by the system at least in part from a first electronic representation so that the different electronic representations are consistent as to the overlapping contract terms included therein.

Claims

1. A method comprising:

creating a first electronic representation of contract terms on a system, wherein said first electronic representation of the contract terms has a first format that is compatible with at least a first application which includes a claim adjudication application, and wherein said electronically represented terms are configured to be processed by said claim adjudication application to determine an amount of payment by said insurer responsive to a submitted claim, further wherein said first electronic representation associates at least one qualifier and a corresponding calculation method with each payment term of the contract;

determining priority of applicability amongst multiple contract terms when the at least one qualifier of more than one contract term is met; and

using, by said system, the first electronic representation of contract terms to generate at least a portion of a second electronic representation of the contract, wherein said second electronic representation of the contract has a second format that is compatible with at least a second application.

2. The method of claim 1 wherein said at least a second application includes a contract management application.

3. The method of claim 1 wherein said contract is a contract between an insurer and a service provider.

4. The method of claim 1 wherein said at least a portion includes financial terms of the contract.

5. The method of claim 1 wherein said at least a portion includes service discount terms of the contract.

6. The method of claim 1 wherein said each payment term governs payment from one party to the contract to another party to the contract.

7. The method of claim 1 wherein the at least one qualifier identifies at least one condition to be satisfied by a claim for payment in order to trigger the corresponding calculation method to be used in calculating an amount of payment.

8. The method of claim 1 wherein said second electronic representation includes a phrase describing a term of the contract.

9. The method of claim 8 wherein said phrase includes at least one sentence.

10. A system comprising:

an adjudication application stored to computer-readable medium;

a contract management application stored to computer-readable medium;

a first electronic representation of contract terms stored to computer-readable medium, wherein said first electronic representation of said contract terms is compatible for use by said adjudication application, further wherein said first electronic representation associates at least one qualifier and a corresponding calculation method with each payment term of the contract and the at least one qualifier identifies at least one condition to be satisfied by a claim for payment in order to trigger the corresponding calculation method to be used in calculating an amount of payment;

in a case wherein there are multiple contract terms, the claim adjudication application determines priority of applicability amongst the multiple contract terms when the at least one qualifier of more than one contract term is met; and

at least one adapter for transforming the first electronic representation of said contract terms to a second electronic representation of the contract terms, wherein said second electronic representation of said contract terms is compatible for use by said contract management application.

11. The system of claim 10 wherein said contract is between an insurer and a service provider.

12. The system of claim 11 wherein said adjudication application comprises a claim adjudication application for processing claims submitted to the insurer from the service provider to determine a payment amount for said claims in accordance with the contract.

13. The system of claim 10 wherein said first electronic representation is not compatible with said contract management application.

14. The system of claim 10 wherein said at least one adapter comprises:

an interface for receiving said first electronic representation;

logic for translating said first electronic representation into said second electronic representation; and

an interface for outputting said second electronic representation.

15. The system of claim 10 wherein said at least one adapter comprises:

a first adapter for receiving said first electronic representation, translating said first representation into an inter-adapter representation of the contract terms, and communicating said inter-adapter representation of the contract terms to a second adapter; and

the second adapter for receiving said inter-adapter representation of the contract terms, and translating said inter-adapter representation into said second electronic representation.

16. The system of claim 15 wherein said inter-adapter representation of the contract terms is a representation in one selected from the group consisting of:

extensible markup language (XML), simple object access protocol (SOAP), web services description language (WSDL), and universal description, discovery and integration (UDDI).

17. A method comprising:

storing to computer-readable medium a first electronic representation of rate terms of at least one contract between an insurer and a service provider, said first electronic representation of rate terms including associating at least one qualifier and a corresponding calculation method with at least one rate term of said contract;

adjudicating, by a claim adjudication application, claims submitted to the insurer by said service provider using said first electronic representation of rate terms, wherein in the case of multiple rate terms, the claim adjudication application determines priority of applicability amongst the multiple rate terms;

importing the rate terms from the first electronic representation to a second electronic representation of the at least one contract stored to computer-readable medium; and

managing, by a contract management application, the at least one contract using said second electronic representation of the at least one contract.

18. The method of claim 17 wherein said first electronic representation of said rate terms is not compatible with said contract management application.

19. The method of claim 18 wherein said importing comprises:

Translating the first electronic representation of the rate terms into said second electronic representation that is compatible with said contract management application.