Patent Issued for Machine structured plan description (USPTO 11393039): Collective Health Inc.

2022 AUG 05 (NewsRx) -- By a News Reporter-Staff News Editor at Insurance Daily News -- A patent by the inventors Chiv, Henning (Castro Valley, CA, US), Gard, Michelle Alicia (San Mateo, CA, US), Khalak, Asif (Belmont, CA, US), Martinez-Ortuno, Sergio (Oakland, CA, US), Wise, Emma Louise (San Francisco, CA, US), filed on December 30, 2019, was published online on July 19, 2022, according to news reporting originating from Alexandria, Virginia, by NewsRx correspondents.

Patent number 11393039 is assigned to Collective Health Inc. (San Mateo, California, United States).

The following quote was obtained by the news editors from the background information supplied by the inventors: “Administrators can offer and manage benefit plans that provide one or more benefits to plan participants. For example, a benefit plan can be a health plan that offers benefits that fully or partially cover the cost of certain medical services for plan participants. In some examples, an administrator can be a third party that administers a benefit plan on behalf of a sponsor, such as an employer that offers health plans to its employees via the administrator.

“The benefits of a particular benefit plan can be explained to plan participants, potential plan participants, sponsors, personnel of the administrator, and/or other audiences through various types of documents. Claims submitted by providers or by plan participants can be adjudicated by the administrator according to the benefits of the benefit plan. For example, the administrator can adjudicate a claim to determine whether to approve or deny the claim, as well as to determine cost sharing parameters of an approved claim, such as how much of the cost of a covered service should be paid by the plan participant and how much should be paid by the sponsor.”

In addition to the background information obtained for this patent, NewsRx journalists also obtained the inventors’ summary information for this patent: “A benefit plan can be a plan or policy that provides one or more benefits or services to plan participants. In some examples, a benefit plan can be a health plan that provides plan participants with benefits including coverage of one or more medical services. In other examples, a benefit plan can be a travel plan that offers various travel benefits, a real-estate lease, an investment portfolio plan, an employee perks and assistance plan, or any other type of plan or policy.

“In some examples, an administrator can administer a benefit plan on behalf of a sponsor. For example, a sponsor can be an employer that offers a health plan to its employees, and the administrator can be a third-party entity that provides plan documentation to plan participants and potential plan participants of the health plan, as well as adjudicating claims against the health plan that have been submitted by plan participants or by medical providers. In other examples, the sponsor can be an insurance company or any other entity that offers a benefit plan, but uses a third-party administrator to administer the benefit plan. In still other examples, the administrator can itself be an insurance company or other entity that directly offers a benefit plan.

“Claims can be filed by various parties against a benefit plan to track usage of benefits, to have the administrator determine whether a provided service is covered by the benefit plan, to have the administrator determine a cost sharing arrangement between parties for a provided service, and/or for other reasons. For example, a sponsor of a benefit plan may submit claims in order to track how benefits are being used by plan participants. In some cases, such sponsor-submitted claims can be submitted to help keep track of how certain benefits are being used by plan participants, and accordingly may be submitted as zero dollar value claims. In other cases, such sponsor-submitted claims can be submitted to determine a cost-sharing arrangement between the sponsor and a plan participant for a particular provided service. Claims can also include claims submitted by service providers that have rendered services to plan participants. Such service providers can include in-network providers associated with the benefit plan and out-of-network providers that are not associated with the benefit plan, such that plan participants may be liable for a higher portion of the cost of a service provided by an out-of-network provider. Claims can also be submitted by plan participants to request reimbursement of costs paid to obtain services.

“When a claim is submitted, the administrator can adjudicate the claim to determine whether to approve or deny the claim. If the claim is approved, the administrator may determine a cost sharing arrangement between the plan participant and a sponsor or another entity associated with the benefit plan. In some examples, administrator personnel can manually adjudicate claims, although an administrator may also have automatic claims adjudication systems that can be configured to adjudicate claims according to particular benefit plans.

“For example, when the benefit plan is a health plan, a medical provider that has rendered services to a plan participant can file a claim against the health plan for the cost of those services. The administrator can then adjudicate the claim. For instance, as part of the adjudication, the administrator may determine that the plan participant is liable for paying 20% of the cost of the services, while the health plan’s sponsor should pay the remaining 80%.”

The claims supplied by the inventors are:

“1. A computer-implemented method comprising: loading, by a plan documentation generator executing via computer-executable instructions on one or more computing devices, a machine structured plan description (MSPD) that defines a benefit plan, wherein the MSPD is an object-based data structure comprising a plurality of plan objects that express attributes of a plurality of benefits of the benefit plan using a domain-specific language; loading, by the plan documentation generator, a plurality of templates associated with multiple audiences, wherein individual ones of the plurality of templates correspond to at least one of different document types or different document formats; and automatically generating, by the plan documentation generator, using the MSPD and based on the plurality of templates, a plurality of plan documents associated with the benefit plan by: determining content elements defined by the plurality of templates; identifying particular plan objects of the MSPD that correspond with the content elements; identifying selected attributes, associated with the particular plan objects that correspond with the content elements, indicating attribute data expressed in the domain-specific language in the MSPD; determining natural language descriptions of the selected attributes, based on corresponding attribute data in the MSPD expressed in the domain-specific language; and incorporating the natural language descriptions into document data defined by the plurality of templates, wherein at least one of the plurality of plan documents is generated at least in part by using a structured natural language processing (SNLP) engine to modify one or more of the natural language descriptions or corresponding document data to contextually match within the at least one of the plurality of plan documents, and wherein automatic generation of the plurality of plan documents based on the attribute data expressed in the domain-specific language in the MSPD causes the natural language descriptions in different plan documents, of the plurality of plan documents, to describe information about the benefit plan relevant to the multiple audiences consistently.

“2. The computer-implemented method of claim 1, wherein the multiple audiences includes plan participants of the benefit plan and potential plan participants of the benefit plan, and at least one of the plurality of templates is configured to cause the plan documentation generator to generate a plan document of the plurality of plan documents as content that explains at least one of the plurality of benefits to the plan participants or the potential plan participants.

“3. The computer-implemented method of claim 2, wherein the content is electronic content for a web site for the plan participants or the potential plan participants.

“4. The computer-implemented method of claim 2, wherein the content is generated in a printable form for printing and physical distribution to the plan participants or the potential plan participants.

“5. The computer-implemented method of claim 1, wherein the multiple audiences includes claims administrators, and the plurality of templates is configured to cause the plan documentation generator to generate a plan document of the plurality of plan documents as a set of claims adjudication rules that instruct the claims administrators how to manually adjudicate a submitted claim according to the benefit plan defined by the MSPD.

“6. The computer-implemented method of claim 1, further comprising: loading, by the plan documentation generator, a second MSPD that defines a revised version of the benefit plan, wherein the second MSPD is a second object-based data structure comprising a second plurality of plan objects that expresses revised attributes of the plurality of benefits of the benefit plan using the domain-specific language; and automatically generating, by the plan document generator, using the second MSPD and based on the plurality of templates, a second plurality of plan documents associated with the revised version of the benefit plan by: identifying second particular plan objects of the second MSPD that correspond with the content elements of the plurality of templates; identifying second selected attributes, associated with the second particular plan objects of the second MSPD, that correspond with the content elements; determining revised natural language descriptions of the second selected attributes, based on corresponding second attribute data in the MSPD expressed in the domain-specific language; and incorporating the revised natural language descriptions into the document data defined by the plurality of templates, wherein automatic generation of the second plurality of plan documents based on the attribute data expressed in the domain-specific language in the second MSPD causes the revised natural language descriptions in different revised plan documents, of the second plurality of plan documents, to describe the information about the benefit plan relevant to the multiple audiences consistently.

“7. The computer-implemented method of claim 1, further comprising: receiving, by an automatic claim adjudication system executing on the one or more computing devices, claim data identifying a service rendered for a plan participant; identifying, by the automatic claim adjudication system, one or more of the plurality of plan objects of the MSPD that correspond to the service; and automatically adjudicating, by the automatic claim adjudication system, the claim data based on the one or more of the plurality of plan objects of the MSPD that correspond to the service.

“8. One or more computing devices comprising: one or more processors; memory storing computer-executable instructions that, when executed by the one or more processors, cause the one or more processors to perform operations comprising: loading a machine structured plan description (MSPD) that defines a benefit plan, wherein the MSPD is an object-based data structure comprising a plurality of plan objects that express attributes of a plurality of benefits of the benefit plan using a domain-specific language; loading a plurality of templates associated with multiple audiences, wherein individual ones of the plurality of templates correspond to at least one of different document types or different document formats; and automatically generating, using the MSPD and based on the plurality of templates, a plurality of plan documents associated with the benefit plan by: determining content elements defined by the plurality of templates; identifying particular plan objects of the MSPD that correspond with the content elements; identifying selected attributes, associated with the particular plan objects that correspond with the content elements, indicating attribute data expressed in the domain-specific language in the MSPD; determining, natural language descriptions of the selected attributes, based on corresponding attribute data in the MSPD expressed in the domain-specific language; and incorporating the natural language descriptions into document data defined by the plurality of templates, wherein at least one of the plurality of plan documents is generated at least in part by using a structured natural language processing (SNLP) engine to modify one or more of the natural language descriptions or corresponding document data to contextually match within the at least one of the plurality of plan documents, and wherein automatic generation of the plurality of plan documents based on the attribute data expressed in the domain-specific language in the MSPD causes the natural language descriptions in different plan documents, of the plurality of plan documents, to describe information about the benefit plan relevant to the multiple audiences consistently.

“9. The one or more computing devices of claim 8, wherein the multiple audiences includes plan participants of the benefit plan and potential plan participants of the benefit plan, and at least one of the plurality of templates is configured to cause a plan document of the plurality of plan documents to be generated as content that explains at least one of the plurality of benefits to plan participants or the potential plan participants.

“10. The one or more computing devices of claim 9, wherein the content is electronic content for a website for the plan participants or the potential plan participants.

“11. The one or more computing devices of claim 8, wherein the multiple audiences includes claims administrators, and the plurality of templates is configured to cause a plan document of the plurality of plan documents to be generated as a set of claims adjudication rules that instruct the claims administrators how to manually adjudicate a submitted claim according to the benefit plan defined by the MSPD.”

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

URL and more information on this patent, see: Chiv, Henning. Machine structured plan description. U.S. Patent Number 11393039, filed December 30, 2019, and published online on July 19, 2022. Patent URL: http://patft.uspto.gov/netacgi/nph-Parser?Sect1=PTO1&Sect2=HITOFF&d=PALL&p=1&u=%2Fnetahtml%2FPTO%2Fsrchnum.htm&r=1&f=G&l=50&s1=11393039.PN.&OS=PN/11393039RS=PN/11393039

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