Automated Data File Conversion for Pharmacy Benefit Management

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Solution Overview

Problem

Pharmacy benefit management companies face significant challenges in managing and processing client benefit plans due to the numerous incompatible file formats used by clients, leading to a time-consuming and costly manual conversion process.

Innovation Solution

An automated system and method for converting client benefit plans from various incompatible formats into compatible benefit packages using hardware processors, which involves receiving client files, applying translation rules to map field values to attribute values, and generating benefit packages that include cost shares, fulfillment channels, and formularies, with the ability to create new formularies if necessary and validate client files.

Engineering Contradictions & Design Principles

VSEngineering Contradiction Analysis

1Adaptability or versatility

If manual conversion process is used to handle various incompatible file formats, then flexibility in handling different client formats is maintained, but processing time and cost increase significantly

Engineering Contradiction:

Improveability to handle different file formatsVSAvoidconversion processing time

Core Design Contradiction:

Adaptability or versatilityVSLoss of time

Solution Approach 1:

The patent implements a universal import engine that can process multiple file formats (Excel, CSV, and other delimited formats) through a single automated system. The engine uses configurable templates and translation rules that can be adapted to different client formats without requiring manual intervention for each format type, thus achieving both versatility and efficiency.

Inventive Principle:

Principle #6Universality (Multi-functionality)

Solution Approach 2:

The system allows dynamic configuration of import parameters including field mappings, translation rules, and template settings. By changing these parameters rather than the underlying processing logic, the system can adapt to different file formats while maintaining consistent automated processing, resolving the contradiction between format flexibility and processing speed.

Inventive Principle:

Principle #35Parameter changes

2Measurement precision

If manual conversion by client benefit analysts is used, then accurate understanding of client-specific formats is achieved, but labor cost and processing time increase

Engineering Contradiction:

Improveaccuracy of format interpretationVSAvoidconversion cost

Core Design Contradiction:

Measurement precisionVSEase of manufacture

Solution Approach 1:

The automated import engine performs self-service by automatically detecting file formats, applying appropriate templates, and executing conversions without human intervention. The system includes built-in validation and error handling that maintains accuracy while eliminating the need for manual analyst involvement in the conversion process itself.

Inventive Principle:

Principle #25Self-service

Solution Approach 2:

The system uses pre-configured templates and translation rules that are prepared in advance for different client formats. These preliminary configurations enable the automated engine to accurately interpret client-specific formats without requiring manual analysis during the conversion process, thus maintaining precision while reducing cost.

Inventive Principle:

Principle #10Preliminary action

3Adaptability or versatility

If multiple file format support is provided, then client compatibility is improved, but system complexity increases

Engineering Contradiction:

Improvefile format compatibilityVSAvoidconversion system complexity

Core Design Contradiction:

Adaptability or versatilityVSDevice complexity

Solution Approach 1:

The patent introduces an intermediary layer consisting of templates and translation rules that sit between the various file formats and the core benefit plan data structure. This intermediary abstraction layer handles the complexity of format differences, allowing the core system to remain simple while supporting multiple formats through standardized intermediate representations.

Inventive Principle:

Principle #24Intermediary (Mediator)

4Productivity

If automated conversion is implemented, then processing speed and cost efficiency are improved, but handling of format variations becomes more difficult

Engineering Contradiction:

Improveconversion processing speedVSAvoidformat variation handling difficulty

Core Design Contradiction:

ProductivityVSDifficulty of detecting and measuring

Solution Approach 1:

The system segments the conversion process into distinct, manageable components: file format detection, template selection, field mapping, translation rule application, and validation. Each segment handles a specific aspect of format variation, making the overall automated process robust and maintainable while preserving high processing speed.

Inventive Principle:

Principle #1Segmentation

Data Source

PatentUS11783429B2Automated conversion of incompatible data files into compatible benefit packages for pharmacy benefit management platform

Publication Date: 2023.10.10 MEDIMPACT HEALTHCARE SYST

AI summary

Automated conversion of incompatible data files into compatible benefit packages for a pharmacy benefit management (PBM) platform. In an embodiment, client files, comprising representations of benefit plans, are received. Each representation comprises a plurality of field values. For each representation, a layout and a set of translation rules are received, the plurality of field values in the representation are mapped to a plurality of attribute values based on the layout, and a benefit package, comprising a plurality of components, is generated by applying the set of translation rules to the plurality of attribute values, such that the benefit package represents the benefit plan.