Automated Software Generator for Insurance Data Reformatting

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Solution Overview

Problem

Insurance processors face challenges in efficiently and consistently reformating incoming insurance-related data from various sources into a consistent format, and in translating complex rules and parameters into usable computer programming instructions for claims processing, which is time-consuming and difficult to modify.

Innovation Solution

A method and system that automatically generates software to reformat insurance-related data using decision tables, converting data into a user-friendly format that can be understood by non-technical users and processed by claims engines, eliminating the need for complex programming.

Engineering Contradictions & Design Principles

VSEngineering Contradiction Analysis

1Reliability

If manual translation of each parameter or rule into coding structure is performed, then accurate processing of insurance claims is achieved, but the process becomes very time consuming and difficult to modify

Engineering Contradiction:

Improveaccuracy of rule translationVSAvoidtime for translating and processing

Core Design Contradiction:

ReliabilityVSLoss of time

Solution Approach 1:

The patent replaces the manual mechanical process of translating each parameter into coding structure with an automated software system. The system automatically translates parameters and rules from source formats into standardized coding structures, eliminating time-consuming manual translation while maintaining accuracy through systematic processing.

Inventive Principle:

Principle #28Mechanics substitution (Replace mechanical system)

Solution Approach 2:

The system enables self-service by allowing the translation and processing system to automatically handle parameter conversion without requiring manual intervention for each rule. The automated software performs the translation task independently, reducing both time consumption and human effort while maintaining reliability.

Inventive Principle:

Principle #25Self-service

2Reliability

If complex programming instructions are used to process insurance rules, then processing accuracy is maintained, but the system becomes difficult for non-technical users to understand and modify

Engineering Contradiction:

Improveprocessing accuracyVSAvoidunderstandability for non-technical users

Core Design Contradiction:

ReliabilityVSEase of operation

Solution Approach 1:

The patent introduces an intermediary layer that bridges complex programming instructions and user-friendly interfaces. This intermediary system translates technical coding structures into readable formats for non-technical users while maintaining the underlying processing accuracy, allowing users to understand and modify rules without needing programming expertise.

Inventive Principle:

Principle #24Intermediary (Mediator)

Solution Approach 2:

The system segments the complex processing system into distinct layers: a technical processing layer that maintains accuracy through standardized coding, and a user interface layer that presents information in understandable formats. This segmentation allows non-technical users to interact with the system through simplified interfaces while the backend maintains processing reliability.

Inventive Principle:

Principle #1Segmentation

3Reliability

If sequential processing of each set of computer programming instructions is performed, then complete processing of all rules is achieved, but the overall processing speed becomes slow

Engineering Contradiction:

Improvecompleteness of rule processingVSAvoidclaims processing speed

Core Design Contradiction:

ReliabilityVSProductivity

Solution Approach 1:

The patent merges multiple individual processing operations into a unified automated system. Instead of sequentially executing separate programming instructions for each parameter, the system combines these operations into an integrated processing workflow that maintains completeness while improving overall processing speed through efficient resource utilization.

Inventive Principle:

Principle #5Merging (Combining)

Solution Approach 2:

The system implements continuous processing where the automated translation and processing operations run continuously without interruption. This eliminates the start-stop nature of sequential manual processing, maintaining complete rule processing while significantly improving throughput and processing speed through uninterrupted automated operation.

Inventive Principle:

Principle #20Continuity of useful action

Data Source

PatentUS8065168B2Method, system and computer program code for automatically generating software for reformatting incoming data

Publication Date: 2011.11.22 CONDUENT BUSINESS SERVICES LLC

AI summary

A method, system and computer program product are provided for creating software that can be used to reformat incoming insurance-related data into a format that conforms to the requirements or preferences of the receiving party. In particular, the software generated is capable of causing a particular action to be taken which will result in the transfer of the received data from one format to another in response to certain conditions being met. These conditions are defined by a decision table, from which the software is automatically generated. A means is further provided for using the received data, which has been reformatted where necessary, to create a user-friendly table that defines the rules and parameters of a particular insurance policy. The table is capable of being easily understood by those unfamiliar with the intricacies of insurance claim processing and programming code, and is further capable of being read by a claims processing engine when processing an insurance claim.