Patent Issued for Systems and methods for providing automated integration and error resolution of records in complex data systems (USPTO 11593393): Cigna Intellectual Property Inc.

2023 MAR 20 (NewsRx) -- By a News Reporter-Staff News Editor at Insurance Daily News -- Cigna Intellectual Property Inc. (Wilmington, Delaware, United States) has been issued patent number 11593393, according to news reporting originating out of Alexandria, Virginia, by NewsRx editors.

The patent’s inventors are Allor, Michael R. (Mesa, AZ, US), Easterlin, Robert M. (Charleston, SC, US), Powell, Rich D. (New Bern, NC, US).

This patent was filed on May 22, 2020 and was published online on February 28, 2023.

From the background information supplied by the inventors, news correspondents obtained the following quote:

“In complex data processing systems, such as medical and insurance claim centers, hundreds or thousands of distinct data records may interrelate with one another such that they all relate to the same “claim” or “case”. As such, in order to update a particular case, updates to hundreds or thousands of records may need to be made. Complicating matters, in many such data processing systems, the underlying data records may be written in a variety of formats and are stored or available in a variety of disparate data systems. For a particular case or claim, some data records may be of significant importance and yet unlinked to other related data records.

“Further, in many such data processing systems, claims or cases are processed linearly using manual intervention. Individual cases or claims are processed by users utilizing dozens or hundreds of distinct data processing tools such as business analytic tools.

“Compounding problems further, in many claim processing systems or case processing systems there is tremendous time sensitivity that requires that a particular claim or case be processed and resolved within a narrow time window. Because of the complexity of such claim or case processing, known systems require significant deployment of manually driven systems in order to effect claim processing. Further, the complex interdependencies of claim data may cause an inaccurate edit to a claim to cause subsequent errors (e.g., a chain reaction of errors) or cause a processing error.

“Accordingly, systems and methods are desired for automated definition, integration, processing, and editing of claim and case records in complex data systems.”

Supplementing the background information on this patent, NewsRx reporters also obtained the inventors’ summary information for this patent: “In one aspect, a claim editing system for automated integration and error resolution of claim records is provided. The claim editing system includes a data warehouse system including a data warehouse processor and a data warehouse memory. The data warehouse system also includes a plurality of claim components. Each claim component is associated with a claim identifier. The claim editing system also includes a claim editing engine in communication with the data warehouse system. The claim editing engine includes a processor and a memory. The processor is configured to extract a set of claim components of the plurality of claim components from the data warehouse system. The processor is also configured to transform the set of claim components to conform to a standardized data format for each of the set of claim components. The processor is further configured to integrate the set of transformed claim components into a set of unified claims by unifying each of the set of transformed claim components having matching claim identifiers into a unified claim. Each unified claim includes unified claim components. The processor is also configured to apply a rule set to the set of unified claims to generate a simulation of execution of the set of claims and to identify errors in the simulated execution. The processor is further configured to transmit an instruction to resolve each identified error associated with each simulated executed claim. The processor is also configured to cause each resolved unified claim to be processed.

“In another aspect, a method for automated integration and error resolution of claim records is provided. The method is performed by a claim editing engine in communication with a data warehouse system. The claim editing engine includes a processor and a memory. The data warehouse system includes a data warehouse processor and a data warehouse memory. The data warehouse system also includes a plurality of claim components each associated with a claim identifier. The method includes extracting a set of claim components of the plurality of claim components from the data warehouse system. The method also includes transforming the set of claim components to conform to a standardized data format for each of the set of claim components. The method additionally includes integrating the set of transformed claim components into a set of unified claims by unifying each of the set of transformed claim components having matching claim identifiers into a unified claim. Each unified claim includes unified claim components. The method also includes applying a rule set to the set of unified claims to generate a simulation of execution of the set of claims and identify errors in the simulated execution. The method further includes transmitting an instruction to resolve each identified error associated with each simulated executed claim. The method additionally includes causing each resolved unified claim to be processed.

“In yet another aspect, a claim editing engine for automated integration and error resolution of claim records is provided. The claim editing engine includes a processor and a memory. The processor is configured to extract a set of claim components of a plurality of claim components. The processor is further configured to transform the set of claim components to conform to a standardized data format for each of the set of claim components. The processor is also configured to integrate the set of transformed claim components into a set of unified claims by unifying each of the set of transformed claim components having matching claim identifiers into a unified claim. Each unified claim includes unified claim components. The processor is additionally configured to apply a rule set to the set of unified claims to generate a simulation of execution of the set of claims and identify errors in the simulated execution. The processor is further configured to transmit an instruction to resolve each identified error associated with each simulated executed claim. The processor is also configured to cause each resolved unified claim to be processed.

“In the drawings, reference numbers may be reused to identify similar and/or identical elements.”

The claims supplied by the inventors are:

“1. A claim editing system for automated integration and error resolution of electronic, health-related claim records that include a plurality of claim components, comprising: a data warehouse system comprising a first processor and a first memory, the data warehouse system further including the electronic, health-related claim records that include the plurality of claim components, wherein each of the plurality of claim components is associated with a claim identifier; and a health-related claim editing engine in communication with the data warehouse system, the health-related claim editing engine comprising a second processor and a second memory, wherein the second processor is configured to: extract a set of claim components of the plurality of claim components from the data warehouse system; transform the set of claim components to conform to a standardized data format for each of the set of claim components; integrate the set of transformed claim components into a set of unified claim records by unifying each of the set of transformed claim components having matching ones of the claim identifiers into a unified claim record of the set of unified claim records, wherein each unified claim record includes unified claim components; apply a rule set to the set of unified claim records to generate a simulated execution of the set of unified claim records and identify predicted errors in the simulated execution, wherein the predicted errors are predicted to cause a cessation of execution of a claim process associated with the set of unified claim records; generate an instruction to resolve each predicted error associated with the simulated execution, wherein the instruction is associated with a recommended edit to resolve the predicted errors so that the claim process is executable without the cessation being caused by the predicted errors, wherein the instruction is associated with a generation of one or more resolved unified claim records based on one or more claim records of the set of unified claim records that are associated with the predicted errors; and cause each of the one or more resolved unified claim records to be processed.

“2. The claim editing system of claim 1, wherein the set of claim components is associated with at least one of a plurality of distinct providers, and the second processor is further configured to: apply the rule set simultaneously to each unified claim record of the at least one of the plurality of distinct providers.

“3. The claim editing system of claim 1, wherein the second processor is further configured to: generate a version control record while applying the rule set, wherein the version control record is included in the simulated execution and the instruction, wherein the version control record identifies the rule set.

“4. The claim editing system of claim 1, wherein the second processor is further configured to: receive a query input statement; and apply an edit engine compiler to the query input statement to generate the rule set.

“5. The claim editing system of claim 4, wherein the second processor is further configured to: receive the query input statement, wherein the query input statement is designed to recursively call the unified claim components from each unified claim record; generate a tree hierarchy for each respective unified claim record of the set of unified claim records such that the tree hierarchy is generated based on the unified claim components for the respective unified claim record; and apply the rule set recursively to the tree hierarchy of each unified claim record.

“6. The claim editing system of claim 1, wherein the recommended edit includes a recommended edit for each predicted error in the simulated execution.

“7. The claim editing system of claim 6, wherein the second processor is further configured to: automatically modify each unified claim record associated with a respective predicted error of the predicted errors by applying the recommended edit associated with the respective predicted error.

“8. A method for automated integration and error resolution of electronic, health-related claim records performed by a health-related claim editing engine in communication with a data warehouse system, the health-related claim editing engine including a processor and a memory, the data warehouse system including a data warehouse processor and a data warehouse memory, the data warehouse system further including the electronic, health-related claim records, the electronic, health-related claim records including a plurality of claim components each associated with a claim identifier, said method comprising: extracting a set of claim components of the plurality of claim components from the data warehouse system; transforming the set of claim components to conform to a standardized data format for each of the set of claim components; integrating the set of transformed claim components into a set of unified claim records by unifying each of the set of transformed claim components having matching ones of the claim identifiers into a unified claim record of the set of unified claim records, wherein each unified claim record includes unified claim components; applying a rule set to the set of unified claim records to generate a simulated execution of the set of unified claim records and identify predicted errors in the simulated execution, wherein the predicted errors are predicted to cause a cessation of execution of a claim process associated with the set of unified claim records; generating an instruction to resolve each predicted error associated with the simulated execution, wherein the instruction is associated with a recommended edit to resolve the predicted errors so that the claim process is executable without the cessation being caused by the predicted errors, wherein the instruction is associated with a generation of one or more resolved unified claim records based on one or more claim records of the set of unified claim records that are associated with the predicted errors; and causing each of the one or more resolved unified claim records to be processed.

“9. The method of claim 8, wherein the set of claim components is associated with at least one of a plurality of distinct providers, and the method further comprises: applying the rule set simultaneously to each unified claim record of the at least one of the plurality of distinct providers.

“10. The method of claim 8, further comprising: generating a version control record while applying the rule set, wherein the version control record is included in the simulated execution and the instruction, wherein the version control record identifies the rule set.

“11. The method of claim 8, further comprising: receiving a query input statement; and applying an edit engine compiler to the query input statement to generate the rule set.

“12. The method of claim 11, further comprising: receiving the query input statement, wherein the query input statement is designed to recursively call the unified claim components from each unified claim record; generating a tree hierarchy for each respective unified claim record of the set of unified claim records such that the tree hierarchy is generated based on the unified claim components for the respective unified claim record; and applying the rule set recursively to the tree hierarchy of each unified claim record.

“13. The method of claim 8, wherein the recommended edit includes a recommended edit for each predicted error in the simulated execution.

“14. The method of claim 13, further comprising: automatically modifying each unified claim record associated with a respective predicted error of the predicted errors by applying the recommended edit associated with the respective predicted error.

“15. A health-related claim editing engine for automated integration and error resolution of electronic, health-related claim records that include a plurality of claim components, the health-related claim editing engine including a processor and a memory, said processor is configured to: extract a set of claim components of the plurality of claim components; transform the set of claim components to conform to a standardized data format for each of the set of claim components; integrate the set of transformed claim components into a set of unified claim records by unifying each of the set of transformed claim components having matching claim identifiers into a unified claim record of the set of unified claim records, wherein each unified claim record includes unified claim components; apply a rule set to the set of unified claim records to generate a simulated execution of the set of unified claim records and identify predicted errors in the simulated execution, wherein the predicted errors are predicted to cause cessation of execution of a claim process associated with the set of unified claim records; generate an instruction to resolve each predicted error associated with the simulated execution, wherein the instruction is associated with a recommended edit to resolve the predicted errors so that the claim process is executable without the cessation being caused by the predicted errors, wherein the instruction is associated with a generation of one or more resolved unified claim records based on one or more claim records of the set of unified claim records that are associated with the predicted errors; and cause each of the one or more resolved unified claim records to be processed.

“16. The health-related claim editing engine of claim 15, wherein the set of claim components is associated with at least one of a plurality of distinct providers, and the processor is further configured to: apply the rule set simultaneously to each unified claim record of the at least one of the plurality of distinct providers.”

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

For the URL and additional information on this patent, see: Allor, Michael R. Systems and methods for providing automated integration and error resolution of records in complex data systems. U.S. Patent Number 11593393, filed May 22, 2020, and published online on February 28, 2023. Patent URL (for desktop use only): https://ppubs.uspto.gov/pubwebapp/external.html?q=(11593393)&db=USPAT&type=ids

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