Graphical Business Rule Editor for Insurance Claims
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Solution Overview
Problem
Existing insurance claim processing systems face challenges in efficiently modifying business rules, particularly in handling trauma severity calculations, due to hard-coded formulas in source code and complex database management, which leads to time-consuming updates and risks of unintended changes affecting multiple 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 transforming source code into object code, and provides access control and audit trails to manage rule modifications.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Reliability
If business rules are hard-coded into source code, then the system maintains stability and consistency, but modifying business rules becomes time-consuming and complex
Solution Approach 1:
The patent segments business rules from source code by implementing them as separate, parameterizable components. Business rules are divided into modular units that can be independently configured and modified without changing the underlying source code, enabling rapid updates while maintaining system stability.
Solution Approach 2:
The patent uses parameter changes to allow business rules to be modified by altering configuration parameters rather than source code. Business rules are defined with adjustable parameters that can be changed through configuration files or user interfaces, enabling flexible modification without compilation or code changes.
2Loss of time
If database entries are modified to change business rules, then updates can be made without source code changes, but it is difficult to determine the impact on other rules and mistakes may not be apparent
Solution Approach 1:
The patent implements feedback mechanisms that automatically track and report the impact of business rule changes. When a rule is modified, the system provides feedback about which other rules or processes are affected, enabling administrators to understand the full impact before implementation and prevent unintended consequences.
Solution Approach 2:
The patent performs preliminary analysis of change impacts before modifications are committed. The system pre-evaluates potential effects of proposed changes on other business rules and processes, allowing administrators to review and approve changes with full awareness of consequences before they are applied.
3Productivity
If multiple business rules share common components in the database, then the database becomes more efficient, but changing a component requires changing multiple rules simultaneously
Solution Approach 1:
The patent segments business rules into hierarchical components with clear parent-child relationships. Common components are organized as reusable templates or parent rules that can be independently modified, and changes automatically propagate to child rules through the hierarchical structure, enabling efficient updates without manual changes to multiple rules.
Solution Approach 2:
The patent implements universal business rule components that serve multiple functions and can be reused across different rules. These modular components are designed to be independently configurable and can be instantiated in multiple contexts, allowing a single change to universally update all rules that utilize that component through automated inheritance or reference mechanisms.
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. The graphical display may allow the user to view, edit and/or create business rules. In some embodiments, one or more human language translations of one or more business rule components may be provided. A human language translation may be substituted for a business rule component in the graphical display.