Graphical Business Rule Editor for Insurance Claim Processing
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Solution Overview
Problem
Insurance companies face challenges in efficiently modifying business rules for claim processing systems, particularly in updating trauma severity calculations, due to hard-coded formulas in source code and complex database management, which can lead to delays and unintended changes affecting other rules.
Innovation Solution
A graphical user interface-based rule editor that allows users to view, edit, and create business rules by combining business rule components, with a compiler to transform source code into object code, and provides access control and audit trails to manage modifications and user privileges.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Device complexity
If business rules are hard-coded into source code, then the system structure is simple, but modifying business rules becomes time-consuming and complex
Solution Approach 1:
The patent segments business rules into separate database tables (e.g., business_rule_components table) from the main source code. This allows business rules to be stored, viewed, and modified independently through a graphical interface without touching the core codebase, thus resolving the contradiction between simple system structure and easy modification.
Solution Approach 2:
The patent introduces a database as an intermediary layer between the source code and business rules. Business rules are stored in database tables and can be modified through a graphical interface that queries and edits database entries, eliminating the need to directly modify source code while maintaining system structure simplicity.
2Ease of manufacture
If business rules are stored in a database, then modifications can be made without changing source code, but it becomes difficult to determine the impact of changes on other rules
Solution Approach 1:
The patent implements a feedback mechanism where the system queries the database to retrieve all business rules that reference a modified business rule component. This feedback loop provides real-time information about the impact of changes, allowing administrators to see which other rules are affected before applying modifications.
Solution Approach 2:
The patent performs preliminary action by querying the database before making changes to identify all affected business rules. The system retrieves and displays the list of rules that reference the modified component, enabling administrators to plan and execute changes carefully while understanding the full scope of impact in advance.
3Adaptability or versatility
If multiple database entries are modified to implement a single business rule change, then the flexibility is increased, but the risk of unintended changes increases
Solution Approach 1:
The patent provides feedback by displaying the complete list of business rules that reference a specific business rule component before allowing modifications. This enables administrators to see exactly which rules will be affected and verify that the intended change is applied correctly, maintaining reliability while preserving flexibility.
4Adaptability or versatility
If source code is modified to meet special user requirements, then customization is achieved, but the standard formulas cannot be easily restored
Solution Approach 1:
The patent segments business rules into the database, allowing customizations to be made as separate database entries rather than modifying source code. When standard formulas need to be restored, administrators can simply delete or update the corresponding database entries, making restoration easy and reversible without affecting the core codebase.
Data Source
AI summary
Methods, systems and carrier media for viewing business rules are disclosed. Components of the business rules may be stored as entries in one or more database tables. A rule editor may access business rule components and assemble the components to form a graphical display of a business rule. In various embodiments, the graphical display may allow the user to view, edit and/or create business rules.