Patent Issued for Distributed ledger system for automated claim adjudication (USPTO 11699131): Synchrony Bank

2023 JUL 28 (NewsRx) -- By a News Reporter-Staff News Editor at Computers, Networks & Communications Daily Daily -- According to news reporting originating from Alexandria, Virginia, by NewsRx journalists, a patent by the inventors Hang, Cheng (Stamford, CT, US), Patel, Ujjval (Stamford, CT, US), Ruan, Justin (Stamford, CT, US), filed on December 16, 2020, was published online on July 11, 2023.

The assignee for this patent, patent number 11699131, is Synchrony Bank (Stamford, Connecticut, United States).

Reporters obtained the following quote from the background information supplied by the inventors:

“Field of the Disclosure

“The present disclosure relates to a secure system for automated claim adjudication and more specifically, to a secure and tamper proof distributed ledger architecture for recording, monitoring and processing of claims between users, service providers and/or any intermediary broker node.

“Description of the Related Art

“Adjudication of claims particularly claims arising from interactions and dealings between a user and a service provider, often involve multiple intermediary parties that result in the processing of such claims become time consuming and costly adding significant overhead administrative costs.

“Further, deficiencies of legacy systems used in recording, monitoring and processing of such claims present significant risk of breach of privacy of parties involved. This is evidenced by the multi billion dollars insurance fraud that exist, which in turn consumes a lot of law enforcement resources to track and prevent such insurance frauds.

“Accordingly, what is needed is a more secure, uniform and cost effective systems for adjudication of claims.”

In addition to obtaining background information on this patent, NewsRx editors also obtained the inventors’ summary information for this patent: “To address the deficiencies in the existing legacy systems used for recording, monitoring and processing of claims between users, service providers and intermediary brokers as well as to improve the time consuming and costly adjudication process, the present disclosure provides a unique and novel distributed ledger system that detects initiation of a claim adjudication process, extracts necessary information from various sources necessary for creating smart contracts based on which the underlying claim is being adjudicated (using novel and unique APIs and compatible record extraction and conversion codes), and processing the claims. The distributed ledger system and the smart contract provides a secure unified claim adjudication system that can prevent attempted unauthorized access to private user information and resulting fraud.

“One aspect of the present disclosure is a distributed ledger system. The distributed ledger system includes a first network node including one or more memories having computer-readable instructions stored therein and one or more processors configured to execute the computer-readable instructions to detect a triggering condition for processing a claim; collect user and broker information for processing the claim; convert the information from a first computer-readable format to a second computer-readable format to yield converted information; validate the converted information based on corresponding digital signatures associated with the converted information to yield validated information; generate claim state objects based on the validated information, the claim state objects being used by each node of the distributed ledger system to execute a smart contract for processing the claim; receive one or more updated claim state objects from a second network node reflecting updated processing status of the claim, the one or more updated claim state objects being used by each node of the distributed ledger system to execute the smart contract for processing the claim; and process the claim based on results of execution of the smart contract using the one or more updated claim state objects.

“One aspect of the present disclosure includes one or more non-transitory computer-readable media comprising computer-readable instructions, which when executed by one or more processors of a first node on a distributed ledger system, cause the first node to detect a triggering condition for processing a claim; collect user and broker information for processing the claim; convert the information from a first computer-readable format to a second computer-readable format to yield converted information; validate the converted information based on corresponding digital signatures associated with the converted information to yield validated information; generate claim state objects based on the validated information, the claim state objects being used by each node of the distributed ledger system to execute a smart contract for processing the claim; receive one or more updated claim state objects from a second network node reflecting updated processing status of the claim, the one or more updated claim state objects being used by each node of the distributed ledger system to execute the smart contract for processing the claim; and process the claim based on results of execution of the smart contract using the one or more updated claim state objects.

“One aspect of the present disclosure includes a method of automated adjudication of claims on a distributed ledger system. The method includes a method of automated adjudication of claims on a distributed ledger system includes detecting, at a first node of the distributed ledger system, a triggering condition for processing a claim; collecting user and broker information for processing the claim; converting the information from a first computer-readable format to a second computer-readable format to yield converted information; validating the converted information based on corresponding digital signatures associated with the converted information to yield validated information; generating claim state objects based on the validated information, the claim state objects being used by each node of the distributed ledger system to execute a smart contract for processing the claim; receiving one or more updated claim state objects from a second network node reflecting updated processing status of the claim, the one or more updated claim state objects being used by each node of the distributed ledger system to execute the smart contract for processing the claim; and processing the claim based on results of execution of the smart contract using the one or more updated claim state objects.”

The claims supplied by the inventors are:

“1. A distributed ledger system comprising: a first network node of a service provider, including one or more memories having computer-readable instructions stored therein and one or more processors configured to execute the computer-readable instructions to: detect a triggering condition for real-time processing of a claim, wherein the triggering condition includes automatically detecting a proximity of end user equipment associated with a user and a premises of a service provider; collect user information associated with the user and broker information associated with a broker for processing the claim via a smart contract, wherein the user information and broker information are collected by the service provider; convert the user information and the broker information from a first computer-readable format to a second computer-readable format to yield converted information, wherein the first computer-readable format is not compatible with the smart contract, and the second computer-readable format is compatible with the smart contract; validate the converted information based on corresponding digital signatures associated with the converted information to yield validated information, wherein the corresponding digital signatures are generated using a cryptographic key known to each node of a blockchain associated with the user, the service provider, and the broker; generate claim state objects based on the validated information, the claim state objects being used by each node of the distributed ledger system to execute a smart contract for processing the claim; receive one or more updated claim state objects from a second network node associated with the broker reflecting updated processing status of the claim, the one or more updated claim state objects being used by each node of the distributed ledger system to execute the smart contract for processing the claim; perform a distributed verification of the smart contract execution, wherein the distributed verification is performed by separately by the first network node, the second network node, and the end user equipment; and process the claim based on results of execution of the smart contract using the one or more updated claim state objects.

“2. The distributed ledger system of claim 1, wherein the triggering condition includes detection of a user terminal within a facility associated with the first network node at a first time and a determination that the user terminal is no longer present at the facility at a second time that is after the first time.

“3. The distributed ledger system of claim 1, wherein the first computer-readable format is Electronic Data Interchange (EDI) format and the second computer-readable format is JSON.

“4. The distributed ledger system of claim 1, wherein the user information includes user identifying information and user insurance information for processing the claim.

“5. The distributed ledger system of claim 1, wherein the first network node is associated with a service provider for which the claim is being processed.

“6. The distributed ledger system of claim 5, wherein the second network node is associated with a broker entity providing claim coverage for a user associated with the claim.

“7. The distributed ledger system of claim 1, wherein the one or more processors are configured to execute the computer-readable instructions to process the claim by completing a cardless transaction using a financial account of a provider associated with the first network node and at least one of a financial account of an insurance provider associated with the second network node and a financial account of a user who is a party to the claim.

“8. The distributed ledger system of claim 1, wherein processing the claim results in a claim status that indicates one of a complete or partial payment for the claim by an entity associated with the second network node.

“9. The distributed ledger system of claim 1, wherein the claim is for a dental procedure provided by a provider associated with the first network node.

“10. One or more non-transitory computer-readable media comprising computer-readable instructions, which when executed by one or more processors of a first network node on a distributed ledger system, cause the first network node to: detect a triggering condition for real-time processing of a claim, wherein the triggering condition includes automatically detecting a proximity of end user equipment associated with a user and a premises of a service provider; collect user information associated with the user and broker information associated with a broker for processing the claim via a smart contract, wherein the user information and broker information are collected by the service provider; convert the user information and the broker information from a first computer-readable format to a second computer-readable format to yield converted information, wherein the first computer-readable format is not compatible with the smart contract, and the second computer-readable format is compatible with the smart contract; validate the converted information based on corresponding digital signatures associated with the converted information to yield validated information, wherein the corresponding digital signatures are generated using a cryptographic key known to each node of a blockchain associated with the user, the service provider, and the broker; generate claim state objects based on the validated information, the claim state objects being used by each node of the distributed ledger system to execute a smart contract for processing the claim; receive one or more updated claim state objects from a second network node associated with the broker reflecting updated processing status of the claim, the one or more updated claim state objects being used by each node of the distributed ledger system to execute the smart contract for processing the claim; perform a distributed verification of the smart contract execution, wherein the distributed verification is performed by separately by the first network node, the second network node, and the end user equipment; and process the claim based on results of execution of the smart contract using the one or more updated claim state objects.

“11. The one or more non-transitory computer-readable media of claim 10, wherein the triggering condition includes detection of a user terminal within a facility associated with the first network node at a first time and a determination that the user terminal is no longer present at the facility at a second time that is after the first time.

“12. The one or more non-transitory computer-readable media of claim 10, wherein the first computer-readable format is Electronic Data Interchange (EDI) format and the second computer-readable format is JSON.

“13. The one or more non-transitory computer-readable media of claim 10, wherein the user information includes user identifying information and user insurance information for processing the claim.

“14. The one or more non-transitory computer-readable media of claim 10, wherein the first network node is associated with a service provider for which the claim is being processed.

“15. The one or more non-transitory computer-readable media of claim 14, wherein the second network node is associated with a broker entity providing claim coverage for a user associated with the claim.

“16. The one or more non-transitory computer-readable media of claim 10, wherein the one or more processors are configured to execute the computer-readable instructions to process the claim by completing a cardless transaction using a financial account of a provider associated with the first network node and at least one of a financial account of an insurance provider associated with the second network node and a financial account of a user who is a party to the claim.

“17. The one or more non-transitory computer-readable media of claim 10, wherein processing the claim results in a claim status that indicates one of a complete or partial payment for the claim by an entity associated with the second network node.

“18. The one or more non-transitory computer-readable media of claim 10, wherein the claim is for a dental procedure provided by a provider associated with the first network node.”

There are additional claims. Please visit full patent to read further.

For more information, see this patent: Hang, Cheng. Distributed ledger system for automated claim adjudication. U.S. Patent Number 11699131, filed December 16, 2020, and published online on July 11, 2023. Patent URL (for desktop use only): https://ppubs.uspto.gov/pubwebapp/external.html?q=(11699131)&db=USPAT&type=ids

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