Emergis Inc. Patent applications |
Patent application number | Title | Published |
20140249975 | INTERACTIVE ELECTRONIC BILL PAYMENT SYSTEM - A system for coordinating the submission and processing of a bill according to predictive payment data of a plan. The system comprises a provider interface and an integrated database for receiving a predictive payment plan submitted from the provider interface. The system also has a predictive payment request of the plan storable in the database, the request including a plurality of predictive payment parameters. An adjudication engine is coupled to the integrated database, and an insertion function is used for inserting the predictive payment parameters, when stored in the database, into an adjudication rule set of the adjudication engine. The adjudication rule set is used for eventual adjudication of the predictive payment data, wherein adjudication of the predictive payment data results in the generation of the bill. The system also has a workflow engine coupled to the integrated database for coordinating the processing of the electronic bill and for updating the bill information in response to the bill processing. A management system is coupled to the integrated database for monitoring the contents of the integrated database accessible by the provider interface, wherein the provider can coordinate real-time retrieval of submission and status details for bill information contained in the integrated database. | 09-04-2014 |
20130166327 | SYSTEM AND METHOD HAVING A HIERARCHICAL MODEL WITH OVERRIDE CAPABILITY FOR GENERATING A FLEXIBLE INSURANCE PLAN - A system and method for implementing an insurance plan to coordinate an adjudication of a submitted claim corresponding to the plan. The plan includes a people model and a benefit model, such as hierarchical trees combined by a plurality of policies. The system and method comprise assigning a first predefined inheritance of global attributes to coupled elements of the people tree and assigning a second predefined inheritance of global attributes to coupled elements of the benefits tree. The system and method also assigning a local administration rule for at least one local attribute of the trees, the assignment between a selected people element of the people tree and a selected benefit element of the benefits tree. The local administration rule overrides the corresponding global attributes of the selected elements, such that resolution of the global attributes with the local attributes for the selected elements provides a rule set for adjudication of the submitted claim. | 06-27-2013 |
20130151287 | INSURANCE CLAIM PROCESSING USING CONTAINERIZED PROCESSING LOGIC - A system and method for processing insurance claims using a set of adjudication rules. The method and system comprises receiving a claim for processing, such that the received claim having claim content including a claim date. Also provided is a database configured for accessing the set of adjudication rules appropriate to the received claim, the set of adjudication rules structured in containers including a primary rule container and secondary rule containers, each of the secondary rule containers being coupled to the primary rule container by a respective container reference, each of the secondary rule containers containing one or more adjudication rules adapted for processing the claim content of the received claim, each of the one or more adjudication rules being coupled to their respective secondary container by a respective rule reference, the set of adjudication rules defining a rule hierarchy. | 06-13-2013 |
20130067321 | METHOD AND SYSTEM FOR CREATING AND PROVIDING A MULTI-TIER NETWORKED SERVICE - A multi-tier application for interaction with a user interface, such as a browser on a PC or PDA. The application comprises a presentation tier (such as a web server with a JSP/servlet engine) and a business logic tier (such as an application server) to manipulate data for subsequent presentation on the user interface. A direction module has a plurality of coupled directions, including a function direction to direct a corresponding functional component to perform a data processing function using the business logic tier and provide a data processing output, and a presentation direction to direct a corresponding presentation component to incorporate the data processing output, when applicable, into a presentation template to produce a presentation element for the user interface. The function component and presentation component are independent and separate from each other, the connection being the function component produces the data and the presentation component consumes the output data. The presentation component is an abstract representation of a general kind of presentation element, each specific presentation element having its layout and format (such as markup language) stored in a different presentation template, and the reference to a specific presentation template for the presentation component can be determined at processing time in the presentation tier. | 03-14-2013 |
20100211415 | MODIFYING CONTAINERIZED PROCESSING LOGIC FOR USE IN INSURANCE CLAIM PROCESSING - A system and method for modifying benefit coverage including a plurality of benefit codes of an insurance plan, the insurance plan for use in adjudicating one or more insurance claims. The system and method including accessing a set of benefit codes structured in a plurality of benefit containers including a primary benefit container and a plurality of secondary benefit containers, each of the plurality of secondary benefit containers being coupled to the primary benefit container by a respective benefit container reference, each of the plurality of secondary benefit containers containing one or more benefit codes adapted for processing a claim content of the one or more insurance claims, each of the one or more benefit codes being coupled to their respective secondary benefit container by a respective benefit reference, the set of benefit codes defining a benefit hierarchy. Also included is selecting the primary benefit container for inclusion in the insurance plan, and then modifying the benefit hierarchy by performing at least one of adding an additional benefit container reference to the primary benefit container, modifying a container benefit parameter of at least one of the benefit container references, or deleting at least one of the existing benefit container references. The modified insurance plan in then stored in a memory; such that the stored modified insurance plan is adapted for subsequent use in adjunction of appropriate insurance claims received by an adjudication system. | 08-19-2010 |
20100211414 | TOOL FOR GENERATING CONTAINERIZED PROCESSING LOGIC FOR USE IN INSURANCE CLAIM PROCESSING - A system and method for configuring a set of adjudication rules for use in processing an insurance claim. The method and system comprise defining an adjudication rule and defining a secondary rule container and coupling the adjudication rule to the secondary rule container by a rule reference associated with the content of the secondary rule container. Also implemented is defining a primary rule container and coupling the secondary rule container to the primary rule container by a container reference associated with the content of the primary rule container, the adjudication rule, the containers, and the rule and container reference defining a rule hierarchy for representing the set of adjudication rules. | 08-19-2010 |
20100211413 | REVISING CONTAINERIZED PROCESSING LOGIC FOR USE IN INSURANCE CLAIM PROCESSING - A system and method for revising one or more hierarchies of an insurance plan, the insurance plan for use in adjudicating one or more insurance claims. The method and system comprising obtaining one or more claims from a claims queue, the claims queue for storing claims selected for review. The system and method comprising accessing at least one of a set of benefit codes or a set of adjudication rules associated with the insurance plan of the obtained one or more claims, wherein at least some of the set of benefit codes or the set of adjudication rules are structured in a plurality of containers. The system and method comprising reconfiguring selected content of the at least one of a set of benefit codes or the set of adjudication rules in view of identified reasons for review of the one or more claims; and storing the reconfigured at least one of a set of benefit codes or the set of adjudication rules in a memory for subsequent use as at least one of a redeployed version of the insurance plan or a revised said at least one of a set of benefit codes or the set of adjudication rules for use in development of other insurance plans for adjudication of claims other than the one or more claims obtained from the claims queue; wherein the revised insurance plan, once deployed, is adapted for use by an adjudication engine for processing insurance claims received by the adjudication engine. | 08-19-2010 |
20100211412 | INSURANCE CLAIM PROCESSING USING CONTAINERIZED PROCESSING LOGIC - A system and method for processing insurance claims using a set of adjudication rules. The method and system comprises receiving a claim for processing, such that the received claim having claim content including a claim date. Also provided is a database configured for accessing the set of adjudication rules appropriate to the received claim, the set of adjudication rules structured in containers including a primary rule container and secondary rule containers, each of the secondary rule containers being coupled to the primary rule container by a respective container reference, each of the secondary rule containers containing one or more adjudication rules adapted for processing the claim content of the received claim, each of the one or more adjudication rules being coupled to their respective secondary container by a respective rule reference, the set of adjudication rules defining a rule hierarchy. | 08-19-2010 |