Contract Term Translation Between Adjudication and Management Systems
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Solution Overview
Problem
Contract management systems and claims processing systems often have disparate electronic representations of contract terms, leading to errors and inconsistencies due to manual configuration and data entry, which complicates the management and adjudication of contracts between insurers and service providers.
Innovation Solution
A system and method that utilize a first electronic representation of a contract to form part of a second electronic representation, enabling consistent representation across disparate applications, such as claim adjudication and contract management systems, through translation and communication of contract terms, reducing manual errors and ensuring accurate reflection of contract terms across systems.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Reliability
If manual configuration and data entry are used to create electronic representations of contract terms in disparate systems, then each system can be independently configured, but errors and inconsistencies arise between systems
Solution Approach 1:
The patent creates an electronic representation of contract terms that can be copied from one system to another. The system generates a standardized electronic format that can be replicated across disparate applications, ensuring consistency without manual re-entry. This copying mechanism eliminates human error while maintaining the ability to distribute contract terms across multiple systems.
Solution Approach 2:
The patent transforms contract terms into a standardized electronic representation format with specific parameters and data structures. By changing the parameter format from manual text entry to structured electronic data, the system enables automated transfer between systems while maintaining consistency. The electronic representation includes standardized fields that can be systematically populated and transferred.
2Productivity
If manual data entry is used to populate contract terms in multiple systems, then each system can be independently configured, but time-consuming delays occur
Solution Approach 1:
The electronic representation of contract terms can be rapidly copied and transferred between systems through automated data exchange. Instead of manual typing and verification in each system, the standardized electronic format allows for quick replication, dramatically reducing the time required to populate multiple systems with identical contract information.
Solution Approach 2:
The system performs preliminary actions by creating the electronic representation in a standardized format that is pre-configured for transfer to multiple systems. The contract terms are structured in advance with appropriate data formats and relationships, enabling automated population of disparate systems without requiring manual configuration steps at each destination.
3Adaptability or versatility
If disparate electronic representations of contract terms are used in different applications, then each application can use its own format, but errors and inconsistencies result
Solution Approach 1:
The patent transforms contract terms into a standardized electronic representation with defined parameters and data structures that can be consistently interpreted across different applications. The electronic format includes standardized fields, data types, and relationships that ensure accurate representation regardless of the destination system, while still allowing each application to access the data in its preferred format.
Solution Approach 2:
The electronic representation of contract terms serves multiple functions across disparate systems while maintaining a single standardized format. The same electronic representation can be used for contract management, claims processing, analytics, and other purposes across different applications, eliminating the need for system-specific variations and ensuring consistency throughout the organization.
Data Source
AI summary
Systems and methods are provided in which contract terms from a first electronic representation of a contract are used to form at least a part of a second electronic representation of the contract. For instance, the first electronic representation of a contract may be formed for use with a first software application, such as an adjudication application, and such first electronic representation of the contract is used by a system to form at least part of a second electronic representation of the contract, wherein such second electronic representation is used by a second software application, such as a contract management application. Disparate applications often utilize different representations of contract terms, and certain embodiments enable a second electronic representation to be formed by the system at least in part from a first electronic representation so that the different electronic representations are consistent as to the overlapping contract terms included therein.