Claim Version Tracking System Using Segmentation
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Solution Overview
Problem
Complexity in processing and managing multiple versions of claims in claims payment systems, which leads to difficulties in accessing, navigating, and displaying claim information in an efficient and customer-friendly manner.
Innovation Solution
A system that receives, stores, and processes claims with unique identifiers, allowing for the tracking and display of multiple claim versions, including original, revised, and processed claims, using a method that associates each version with a date, time, and internal claim identifier, enabling efficient navigation and display of claim versions.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Reliability
If multiple claim versions are stored and processed in a claims payment system, then the system can track the complete claim life cycle and processing history, but the system complexity increases significantly making it difficult to access, navigate, and display claim information
Solution Approach 1:
The patent segments claim information into distinct version iterations, where each version represents a specific state of the claim through the processing workflow. This segmentation allows the system to maintain complete historical records while organizing data in manageable, discrete units that can be individually accessed and displayed without overwhelming system complexity.
Solution Approach 2:
The patent introduces an intermediary version identification mechanism that mediates between the complex backend processing system and the user interface. This intermediary layer provides standardized access points and navigation structures, allowing users to easily access and navigate claim versions without directly interacting with the underlying system complexity.
2Loss of information
If multiple claim versions are stored with detailed processing history, then complete claim life cycle information is maintained, but the difficulty of accessing and navigating claim information increases
Solution Approach 1:
The patent implements dynamic version display capabilities that adapt to user needs and context. The system can dynamically adjust which claim versions are displayed, how they are organized, and what level of detail is shown. This dynamic approach maintains complete information availability while providing flexible, user-friendly access that reduces navigation difficulty.
Solution Approach 2:
The patent applies preliminary organization and indexing of claim versions during the processing workflow. By pre-structuring the data with clear version identifiers, timestamps, and processing status markers, the system prepares information for efficient retrieval and display. This preliminary action reduces the effort required for users to access and navigate claim information later.
3Productivity
If the system processes claims according to dynamic policies and rules resulting in multiple claim versions, then accurate claim processing is achieved, but the complexity of displaying and presenting claim information to customers increases
Solution Approach 1:
The patent applies local quality by providing different display representations of claim versions tailored to specific user roles, devices, and contexts. Rather than using a single complex display format for all users, the system customizes the presentation of claim information based on local requirements. This allows accurate processing of multiple versions while simplifying the display complexity for each specific user scenario.
4Measurement precision
If the system maintains detailed records of all claim versions with dates, times, and identifiers, then accurate tracking of claim life cycle is achieved, but the complexity of managing and navigating these records increases
Solution Approach 1:
The patent adds temporal and hierarchical dimensions to the organization of claim versions. By structuring versions along time axes with clear chronological ordering and adding hierarchical classification based on processing stages, the system transforms a potentially flat, complex dataset into a multi-dimensional structure. This dimensional organization makes navigation more intuitive while maintaining precise tracking of all version details.
Data Source
AI summary
Systems, methods, apparatus, and computer program products are provided for accessing, navigating, and displaying multiple versions of claims in an efficient and customer-friendly manner. In various embodiments, claims can be processed and stored such that they can be displayed via an interface in a graphical format (e.g., textual, circular, hierarchical, etc.).