Benefit Plan Management via Traceable Component Assembly
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Solution Overview
Problem
Current benefit management systems face challenges in managing intricate benefit plans due to lack of end-to-end traceability, leading to errors, increased costs, and compliance issues, as they rely on manual and error-prone methods, making it difficult to accurately reflect client intent and identify cross-dependencies among plan components.
Innovation Solution
An interactive dashboard and automated system for generating and assembling benefit components and rules, creating a benefit plan file with metadata that provides end-to-end traceability, enabling accurate and automatic benefit plan creation and management, facilitating canonical searches, impact reports, and reducing manual identification of cross-dependencies.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Reliability
If manual techniques (spreadsheets, emails, handwritten notes) are used to capture and manage benefits, then flexibility in benefit plan design is maintained, but error rates increase and audit readiness deteriorates
Solution Approach 1:
The patent segments the benefit plan into discrete, identifiable components with unique identifiers. Each component (e.g., coverage rules, provider networks, cost-sharing arrangements) is broken down into manageable units that can be individually tracked, validated, and audited. This segmentation enables systematic management of complex benefit plans while maintaining accuracy through structured decomposition.
Solution Approach 2:
The patent introduces an intermediary system that acts as a bridge between manual benefit plan design and automated processing. This intermediary captures user intent, translates it into structured data representations, and maintains traceability links. The intermediary layer enables automated error checking and audit readiness without eliminating the flexibility of manual plan design processes.
2Loss of information
If end-to-end traceability is implemented across all benefit plan components, then audit readiness and error identification improve, but system complexity and implementation costs increase
Solution Approach 1:
The patent establishes traceability links and metadata structures during the initial benefit plan creation and component assembly phases, rather than attempting to add them later. User intent is captured and associated with each component at the time of definition, creating an inherent traceability framework that simplifies subsequent auditing and error tracking without requiring complex retroactive tracking systems.
3Productivity
If automated systems are used to process millions of claims, then processing speed and productivity increase, but the ability to identify root causes of errors and track cross-dependencies deteriorates
Solution Approach 1:
The patent implements feedback mechanisms that track the provenance and interdependencies of benefit plan components throughout the claims processing pipeline. When errors occur in automated claims processing, the system uses stored traceability information to trace back through the processing steps and identify the root cause. Cross-dependency tracking enables the system to understand how changes in one component affect other components, facilitating rapid error identification and correction while maintaining high processing volumes.
Data Source
AI summary
A system for providing end-to-end traceable benefit plans includes an intake engine configured to generate, from input source data, a plurality of benefit plan components having one or more cross-dependencies with respect to each other, wherein the benefit plan components include: data structures reflecting benefit plan aspects and associated rules for implementation with respect to the benefit plan. The system includes an intake dashboard configured to intake the input source data provided by a user via the intake dashboard, the input source data capturing user intent with respect to benefit plan design and/or configuration. The system includes an extractor configured to extract the input source data from source systems, and an assembly module configured to assemble a benefit plan file from the benefit plan components, the benefit plan file associating benefit components with and across workflows and systems. The system includes a claims processing IT environment configured to load the benefit plan file, and to process claims in accordance with the benefit plan file.