公开(公告)号：US20060150107A1

公开(公告)日：2006-07-06

申请号：US11025898

申请日：2005-01-03

申请人： Raymond Leung ,  Clayton Russell ,  Jim Josephs ,  Rob Tholl

发明人： Raymond Leung ,  Clayton Russell ,  Jim Josephs ,  Rob Tholl

IPC分类号： G06F17/00 ,  G06F17/24 ,  G06F17/21 ,  G06F3/00

CPC分类号： G06F17/243

摘要： A system and method for configuring a user formset for display on a user interface of a client computer, the client computer coupled by a network to a formset server, the user formset for providing interaction with a network transaction, the user formset described in a structured definition language. The system and method comprise: requesting the user formset from the server according to at least one formset generation criterion; selecting a first overlay for application to a master formset, the first overlay including first components based on a role of the user; applying the first overlay to the content of the master formset for generating a role based version of the master formset; selecting a second overlay for application to the role based version, the second overlay including second components based on settings particular for the user functioning in the role; and applying the second overlay to the content of the role based version for generating the user formset; wherein the user formset is subsequently rendered on the user interface of the client computer.

摘要翻译： 一种用于配置用户表单以在客户端计算机的用户界面上显示的系统和方法，所述客户端计算机通过网络耦合到表单服务器，用于提供与网络事务的交互的用户表单集，所述用户表单集中描述于结构化 定义语言 该系统和方法包括：根据至少一个格式集生成标准从服务器请求用户表单; 选择用于应用于主表单的第一叠加层，所述第一覆盖包括基于所述用户角色的第一组件; 将所述第一覆盖应用于所述主模板集的内容以生成所述主模板的基于角色的版本; 为应用于所述基于角色的版本选择第二重叠，所述第二覆盖包括基于所述用户在角色中起作用的特定设置的第二组件; 以及将所述第二覆盖应用于所述基于角色的版本的内容以生成所述用户形式集; 其中用户表单随后被呈现在客户端计算机的用户界面上。

公开(公告)号：US07734999B2

公开(公告)日：2010-06-08

申请号：US11025898

申请日：2005-01-03

申请人： Raymond Leung ,  Clayton Russell ,  Jim Josephs ,  Rob Tholl

发明人： Raymond Leung ,  Clayton Russell ,  Jim Josephs ,  Rob Tholl

IPC分类号： G06F17/00

CPC分类号： G06F17/243

摘要： A system and method for configuring a user formset for display on a user interface of a client computer, the client computer coupled by a network to a formset server, the user formset for providing interaction with a network transaction, the user formset described in a structured definition language. The system and method comprise: requesting the user formset from the server according to at least one formset generation criterion; selecting a first overlay for application to a master formset, the first overlay including first components based on a role of the user; applying the first overlay to the content of the master formset for generating a role based version of the master formset; selecting a second overlay for application to the role based version, the second overlay including second components based on settings particular for the user functioning in the role; and applying the second overlay to the content of the role based version for generating the user formset; wherein the user formset is subsequently rendered on the user interface of the client computer.

摘要翻译： 一种用于配置用户表单以在客户端计算机的用户界面上显示的系统和方法，所述客户端计算机通过网络耦合到表单服务器，用于提供与网络事务的交互的用户表单集，所述用户表单集中描述在结构化 定义语言 该系统和方法包括：根据至少一个格式集生成标准从服务器请求用户表单; 选择用于应用于主表单的第一叠加层，所述第一覆盖包括基于所述用户角色的第一组件; 将所述第一覆盖应用于所述主模板集的内容以生成所述主模板的基于角色的版本; 为应用于所述基于角色的版本选择第二重叠，所述第二覆盖包括基于所述用户在角色中起作用的特定设置的第二组件; 以及将所述第二覆盖应用于所述基于角色的版本的内容以生成所述用户形式集; 其中用户表单随后被呈现在客户端计算机的用户界面上。

公开(公告)号：US08825504B2

公开(公告)日：2014-09-02

申请号：US12388320

申请日：2009-02-18

申请人： Rob Tholl ,  Raymond Leung ,  Clayton Russell

发明人： Rob Tholl ,  Raymond Leung ,  Clayton Russell

IPC分类号： G06Q40/00

CPC分类号： G06Q40/00 ,  G06Q40/08

摘要： A system and method for modifying benefit coverage including a plurality of benefit codes of an insurance plan, the insurance plan for use in adjudicating one or more insurance claims. The system and method including accessing a set of benefit codes structured in a plurality of benefit containers including a primary benefit container and a plurality of secondary benefit containers, each of the plurality of secondary benefit containers being coupled to the primary benefit container by a respective benefit container reference, each of the plurality of secondary benefit containers containing one or more benefit codes adapted for processing a claim content of the one or more insurance claims, each of the one or more benefit codes being coupled to their respective secondary benefit container by a respective benefit reference, the set of benefit codes defining a benefit hierarchy. Also included is selecting the primary benefit container for inclusion in the insurance plan, and then modifying the benefit hierarchy by performing at least one of adding an additional benefit container reference to the primary benefit container, modifying a container benefit parameter of at least one of the benefit container references, or deleting at least one of the existing benefit container references. The modified insurance plan in then stored in a memory; such that the stored modified insurance plan is adapted for subsequent use in adjunction of appropriate insurance claims received by an adjudication system.

摘要翻译： 一种用于修改利益范围的系统和方法，包括保险计划的多个利益代码，用于裁定一个或多个保险索赔的保险计划。 所述系统和方法包括访问一组结构在多个利益容器中的益处代码，包括主要利益集装箱和多个次级利益集装箱，所述多个次级利益集装箱中的每一个通过相应的利益耦合到主要利益集装箱 所述多个二级利益集合体中的每一个包含适于处理所述一个或多个保险索赔的权利要求内容的一个或多个利益代码，所述一个或多个利益代码中的每个利益代码通过相应的第 利益参考，定义利益层次的一组效益代码。 还包括选择主要利益容器以包含在保险计划中，然后通过执行至少一个对主要利益集团添加附加利益容器参考来修改利益层级，修改至少一个的容器利益参数 或者删除至少一个现有的益处容器引用。 修改后的保险计划随后存储在记忆中; 使得存储的修改的保险计划适用于随后用于协调由裁定系统接收的适当的保险索赔。

公开(公告)号：US20100211415A1

公开(公告)日：2010-08-19

申请号：US12388320

申请日：2009-02-18

申请人： Rob Tholl ,  Raymond Leung ,  Clayton Russell

发明人： Rob Tholl ,  Raymond Leung ,  Clayton Russell

IPC分类号： G06Q40/00 ,  G06F17/30

CPC分类号： G06Q40/00 ,  G06Q40/08

摘要： A system and method for modifying benefit coverage including a plurality of benefit codes of an insurance plan, the insurance plan for use in adjudicating one or more insurance claims. The system and method including accessing a set of benefit codes structured in a plurality of benefit containers including a primary benefit container and a plurality of secondary benefit containers, each of the plurality of secondary benefit containers being coupled to the primary benefit container by a respective benefit container reference, each of the plurality of secondary benefit containers containing one or more benefit codes adapted for processing a claim content of the one or more insurance claims, each of the one or more benefit codes being coupled to their respective secondary benefit container by a respective benefit reference, the set of benefit codes defining a benefit hierarchy. Also included is selecting the primary benefit container for inclusion in the insurance plan, and then modifying the benefit hierarchy by performing at least one of adding an additional benefit container reference to the primary benefit container, modifying a container benefit parameter of at least one of the benefit container references, or deleting at least one of the existing benefit container references. The modified insurance plan in then stored in a memory; such that the stored modified insurance plan is adapted for subsequent use in adjunction of appropriate insurance claims received by an adjudication system.

摘要翻译： 一种用于修改利益范围的系统和方法，包括保险计划的多个利益代码，用于裁定一个或多个保险索赔的保险计划。 所述系统和方法包括访问一组结构在多个利益容器中的益处代码，包括主要利益集装箱和多个次级利益集装箱，所述多个次级利益集装箱中的每一个通过相应的利益耦合到主要利益集装箱 所述多个二级利益集合体中的每一个包含适于处理所述一个或多个保险索赔的权利要求内容的一个或多个利益代码，所述一个或多个利益代码中的每个利益代码通过相应的第 利益参考，定义利益层次的一组效益代码。 还包括选择主要利益容器以包含在保险计划中，然后通过执行至少一个对主要利益集团添加附加利益容器参考来修改利益层级，修改至少一个的容器利益参数 或者删除至少一个现有的益处容器引用。 修改后的保险计划随后存储在记忆中; 使得存储的修改的保险计划适用于随后用于协调由裁定系统接收的适当的保险索赔。

公开(公告)号：US08355930B2

公开(公告)日：2013-01-15

申请号：US12388218

申请日：2009-02-18

申请人： Rob Tholl ,  Raymond Leung ,  Clayton Russell

发明人： Rob Tholl ,  Raymond Leung ,  Clayton Russell

IPC分类号： G06Q40/00

CPC分类号： G06Q40/08

摘要： A system and method for processing insurance claims using a set of adjudication rules. The method and system comprises receiving a claim for processing, such that the received claim having claim content including a claim date. Also provided is a database configured for accessing the set of adjudication rules appropriate to the received claim, the set of adjudication rules structured in containers including a primary rule container and secondary rule containers, each of the secondary rule containers being coupled to the primary rule container by a respective container reference, each of the secondary rule containers containing one or more adjudication rules adapted for processing the claim content of the received claim, each of the one or more adjudication rules being coupled to their respective secondary container by a respective rule reference, the set of adjudication rules defining a rule hierarchy.

摘要翻译： 使用一套裁决规则处理保险索赔的制度和方法。 所述方法和系统包括接收处理权利要求，使得所接收的权利要求具有包括权利要求日期的权利要求内容。 还提供了一种数据库，其被配置用于访问适合所接收的权利要求的一组裁决规则，该组裁定规则被构造在包括主规则容器和辅助规则容器的容器中，每个辅助规则容器被耦合到主规则容器 通过相应的容器参考，每个辅助规则容器包含适于处理所接收的权利要求的权利要求内容的一个或多个裁决规则，所述一个或多个裁定规则中的每一个通过相应的规则引用耦合到它们各自的辅助容器， 定义规则层级的一组裁决规则。

公开(公告)号：US20100211414A1

公开(公告)日：2010-08-19

申请号：US12388294

申请日：2009-02-18

申请人： Rob Tholl ,  Raymond Leung ,  Clayton Russell

发明人： Rob Tholl ,  Raymond Leung ,  Clayton Russell

IPC分类号： G06Q40/00

CPC分类号： G06Q40/00 ,  G06Q40/08

摘要： A system and method for configuring a set of adjudication rules for use in processing an insurance claim. The method and system comprise defining an adjudication rule and defining a secondary rule container and coupling the adjudication rule to the secondary rule container by a rule reference associated with the content of the secondary rule container. Also implemented is defining a primary rule container and coupling the secondary rule container to the primary rule container by a container reference associated with the content of the primary rule container, the adjudication rule, the containers, and the rule and container reference defining a rule hierarchy for representing the set of adjudication rules.

摘要翻译： 一种用于配置一组用于处理保险索赔的裁决规则的系统和方法。 方法和系统包括定义裁决规则并定义辅助规则容器，并通过与辅助规则容器的内容相关联的规则引用将裁决规则耦合到辅助规则容器。 还实现了定义主规则容器，并通过与主规则容器的内容，裁决规则，容器以及定义规则层次结构的规则和容器引用相关联的容器引用将辅助规则容器耦合到主规则容器 代表一套审判规则。

公开(公告)号：US10192260B2

公开(公告)日：2019-01-29

申请号：US12388294

申请日：2009-02-18

申请人： Rob Tholl ,  Raymond Leung ,  Clayton Russell

发明人： Rob Tholl ,  Raymond Leung ,  Clayton Russell

IPC分类号： G06Q40/00 ,  G06Q40/08

摘要： A system and method for configuring a set of adjudication rules for use in processing an insurance claim. The method and system comprise defining an adjudication rule and defining a secondary rule container and coupling the adjudication rule to the secondary rule container by a rule reference associated with the content of the secondary rule container. Also implemented is defining a primary rule container and coupling the secondary rule container to the primary rule container by a container reference associated with the content of the primary rule container, the adjudication rule, the containers, and the rule and container reference defining a rule hierarchy for representing the set of adjudication rules.

公开(公告)号：US20100211412A1

公开(公告)日：2010-08-19

申请号：US12388218

申请日：2009-02-18

申请人： Rob Tholl ,  Raymond Leung ,  Clayton Russell

发明人： Rob Tholl ,  Raymond Leung ,  Clayton Russell

IPC分类号： G06Q40/00

CPC分类号： G06Q40/08

摘要： A system and method for processing insurance claims using a set of adjudication rules. The method and system comprises receiving a claim for processing, such that the received claim having claim content including a claim date. Also provided is a database configured for accessing the set of adjudication rules appropriate to the received claim, the set of adjudication rules structured in containers including a primary rule container and secondary rule containers, each of the secondary rule containers being coupled to the primary rule container by a respective container reference, each of the secondary rule containers containing one or more adjudication rules adapted for processing the claim content of the received claim, each of the one or more adjudication rules being coupled to their respective secondary container by a respective rule reference, the set of adjudication rules defining a rule hierarchy.

摘要翻译： 使用一套裁决规则处理保险索赔的制度和方法。 所述方法和系统包括接收处理权利要求，使得所接收的权利要求具有包括权利要求日期的权利要求内容。 还提供了一种数据库，其被配置用于访问适合所接收的权利要求的一组裁决规则，该组裁定规则被构造在包括主规则容器和辅助规则容器的容器中，每个辅助规则容器被耦合到主规则容器 通过相应的容器参考，每个辅助规则容器包含适于处理所接收的权利要求的权利要求内容的一个或多个裁决规则，所述一个或多个裁定规则中的每一个通过相应的规则引用耦合到其相应的辅助容器， 定义规则层级的一组裁决规则。

公开(公告)号：US20060149784A1

公开(公告)日：2006-07-06

申请号：US11025912

申请日：2005-01-03

申请人： Rob Tholl ,  Clayton Russell

发明人： Rob Tholl ,  Clayton Russell

IPC分类号： G06Q40/00 ,  G06F17/00

CPC分类号： G06Q10/10 ,  G06Q40/08

摘要： A system and method for configuring an adjudication system to adjudicate a claim transaction. The system and method comprise: receiving the claim transaction containing line items describing an insured service for a recipient to be financed by a payer for the insured service; providing an adjudication engine for coordinating the adjudication processing of the received claim transaction; representing the claim transaction as a plurality of business objects coupled to a database such that the business objects are selected from a set of available business objects, the business objects coupled to the adjudication engine and configured for containing data instances of the claim transaction; and selecting a plurality of adjudication modules for coupling to the plurality of business objects, the plurality of adjudication modules selected from a set of available adjudication modules, the selected adjudication modules configured for providing business logic applied to the business objects during the adjudication processing to manipulate the data instances of the business objects; wherein the configured adjudication system adjudicates the data instances of the business objects according to the business logic of the selected adjudication modules for determining an adjudication status of the claim transaction.

摘要翻译： 一种用于配置裁决系统来判断索赔交易的系统和方法。 所述系统和方法包括：接收所述索赔交易，其中包含描述被保险服务的订单项，所述订单项将由所述被保险服务的付款人为所述接收者提供资金; 提供用于协调接收到的索赔交易的裁决处理的裁决引擎; 将所述索赔交易表示为耦合到数据库的多个业务对象，使得从一组可用业务对象中选择所述业务对象，所述业务对象耦合到所述判定引擎并且被配置为包含所述权利交易的数据实例; 以及选择用于耦合到所述多个业务对象的多个裁决模块，所述多个裁判模块从一组可用的裁定模块中选择，所述裁决模块被配置为在裁决处理期间提供应用于业务对象的业务逻辑以操纵 业务对象的数据实例; 其中所述配置的裁定系统根据所选择的裁定模块的业务逻辑来裁定所述业务对象的数据实例，以确定所述权利交易的判定状态。

公开(公告)号：US20100211413A1

公开(公告)日：2010-08-19

申请号：US12388283

申请日：2009-02-18

申请人： Rob Tholl ,  Raymonf Leung ,  Clayton Russell

发明人： Rob Tholl ,  Raymonf Leung ,  Clayton Russell

IPC分类号： G06Q40/00 ,  G06Q10/00

CPC分类号： G06Q10/00 ,  G06Q40/00 ,  G06Q40/08

摘要： A system and method for revising one or more hierarchies of an insurance plan, the insurance plan for use in adjudicating one or more insurance claims. The method and system comprising obtaining one or more claims from a claims queue, the claims queue for storing claims selected for review. The system and method comprising accessing at least one of a set of benefit codes or a set of adjudication rules associated with the insurance plan of the obtained one or more claims, wherein at least some of the set of benefit codes or the set of adjudication rules are structured in a plurality of containers. The system and method comprising reconfiguring selected content of the at least one of a set of benefit codes or the set of adjudication rules in view of identified reasons for review of the one or more claims; and storing the reconfigured at least one of a set of benefit codes or the set of adjudication rules in a memory for subsequent use as at least one of a redeployed version of the insurance plan or a revised said at least one of a set of benefit codes or the set of adjudication rules for use in development of other insurance plans for adjudication of claims other than the one or more claims obtained from the claims queue; wherein the revised insurance plan, once deployed, is adapted for use by an adjudication engine for processing insurance claims received by the adjudication engine.

摘要翻译： 一种用于修改保险计划的一个或多个层次结构的系统和方法，用于裁定一个或多个保险索赔的保险计划。 所述方法和系统包括从权利要求队列获得一个或多个权利要求，所述权利要求队列用于存储选择进行审查的权利要求。 所述系统和方法包括访问与所获得的一个或多个权利要求的保险计划相关联的一组利益代码或一组判定规则中的至少一个，其中所述一组利益代码或该组判定规则中的至少一些 构造在多个容器中。 考虑到所述一个或多个权利要求的审查理由，所述系统和方法包括重新配置一组利益代码集合或所述一组裁定规则中的至少一个的所选内容; 以及将重新配置的一组利益代码或一组判定规则中的至少一个存储在存储器中，用于随后使用作为保险计划的重新部署版本或经修改的一组利益代码中的至少一个 或用于制定其他保险计划的裁决规则的一套，用于裁决除了从索赔队列获得的一个或多个权利要求之外的索赔; 其中修改后的保险计划一经部署，适用于裁定引擎用于处理由裁定引擎收到的保险索赔。