US 11,232,092 B2Granted

Workflow automation on policy updates

AssigneeEnsemble RCM, LLC

InventorsPieter Schouten, Ryan Miller, Michael Wilson, John Bradford Hunter

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Abstract

Embodiments of the present disclosure are directed to methods and systems for the timely processing of records exchanged between service provider systems and responsible entity systems by a records management and processing system. More specifically, the records management and processing system can maintain a set of rules defining conditions for processing records and associated actions to affect that processing upon satisfaction of or failure to satisfy the conditions of that rule. Updates to some or all of these records can be received from a data update service. The records management and processing system can apply the rules to the records and assign tags to the records based on the received update information and the conditions defined in the applied rules. The records management and processing system can then process the updated records according to workflows for processing the updated records based on the assigned tags and applied rules.

Claims20

Dependent claims

A method for implementing updates directed to the processing of database records, the method comprising:

maintaining, by a records management and processing system, a plurality of records in a database, each record of the plurality of records comprising a record of a service provided to a consumer by a service provider of a plurality of service providers and identifying at least one required action by at least one responsible entity of a plurality of responsible entities and wherein the records management and processing system comprises an intermediary between systems of the plurality of service providers and systems of the plurality of responsible entities;
processing, by the records management and processing system, the plurality of records according to one or more workflows executed by the records management and processing system, wherein the one or more workflows process the plurality of records based on one or more rules applied to the plurality of records;
receiving, by the records management and processing system from a data update service, a set of update information directed to the processing of the plurality of records, wherein the update information is collected by the data update service from the systems of the plurality of responsible entities and defines requirements of one or more of the responsible entities to be satisfied by the plurality of service providers or systems of the plurality of service providers, the requirements comprising one or more of procedures to be followed when processing one or more records of the plurality of records, formatting required for one or more records of the plurality of records, additional information required for one or more records of the plurality of records, or processes to be performed when processing one or more records of the plurality of records;
parsing, by the records management and processing system, the received set of update information into one or more sets of instructions related to processing of one or more records of the plurality of records;
assigning, by the records management and processing system, each of the one or more sets of instructions to one or more categories of a plurality of pre-defined categories of resources, each of the plurality of pre-defined categories of resources comprising one or more resources of the records management and processing system performing processing on the plurality of workflows according to the one or more workflows;
and
forwarding, by the records management and processing system, the one or more sets of instructions to each of the one or more resources in the one or more categories to which the sets of instructions have been assigned.

4 more elements

A system comprising:

a processor;
and
a memory coupled with and readable by the processor and storing therein a set of instructions which, when executed by the processor, causes the processor to implement updates directed to the processing of database records by:
maintaining a plurality of records in a database, each record of the plurality of records comprising a record of a service provided to a consumer by a service provider of a plurality of service providers and identifying at least one required action by at least one responsible entity of a plurality of responsible entities and wherein the records management and processing system comprises an intermediary between systems of the plurality of service providers and systems of the plurality of responsible entities;
processing the plurality of records according to one or more workflows executed by the records management and processing system, wherein the one or more workflows process the plurality of records based on one or more rules applied to the plurality of records;
receiving, from a data update service, a set of update information directed to the processing of the plurality of records, wherein the update information is collected by the data update service from the systems of the plurality of responsible entities and defining requirements of one or more of the responsible entities to be satisfied by the plurality of service providers or systems of the plurality of service providers, the requirements comprising one or more of procedures to be followed when processing one or more records of the plurality of records, formatting required for one or more records of the plurality of records, additional information required for one or more records of the plurality of records, or processes to be performed when processing one or more records of the plurality of records;
parsing the received set of update information into one or more sets of instructions related to processing of one or more records of the plurality of records;
assigning each of the one or more sets of instructions to one or more categories of a plurality of pre-defined categories of resources, each of the plurality of pre-defined categories of resources comprising one or more resources of the records management and processing system performing processing on the plurality of workflows according to the one or more workflows;
and
forwarding the one or more sets of instructions to each of the one or more resources in the one or more categories to which the sets of instructions have been assigned.

7 more elements

A non-transitory, computer-readable medium comprising a set of instructions stored therein which, when executed by a processor, causes the processor to implementing updates directed to the processing of database records by:

maintaining, by a records management and processing system, a plurality of records in a database, each record of the plurality of records comprising a record of a service provided to a consumer by a service provider of a plurality of service providers and identifying at least one required action by at least one responsible entity of a plurality of responsible entities and wherein the records management and processing system comprises an intermediary between systems of the plurality of service providers and systems of the plurality of responsible entities;
processing, by the records management and processing system, the plurality of records according to one or more workflows executed by the records management and processing system, wherein the one or more workflows process the plurality of records based on one or more rules applied to the plurality of records;
receiving, by the records management and processing system from a data update service, a set of update information directed to the processing of the plurality of records, wherein the update information is collected by the data update service from the systems of the plurality of responsible entities and defining requirements of one or more of the responsible entities to be satisfied by the plurality of service providers or systems of the plurality of service providers, the requirements comprising one or more of procedures to be followed when processing one or more records of the plurality of records, formatting required for one or more records of the plurality of records, additional information required for one or more records of the plurality of records, or processes to be performed when processing one or more records of the plurality of records;
parsing, by the records management and processing system, the received set of update information into one or more sets of instructions related to processing of one or more records of the plurality of records;
assigning, by the records management and processing system, each of the one or more sets of instructions to one or more categories of a plurality of pre-defined categories of resources, each of the plurality of pre-defined categories of resources comprising one or more resources of the records management and processing system performing processing on the plurality of workflows according to the one or more workflows;
and
forwarding, by the records management and processing system, the one or more sets of instructions to each of the one or more resources in the one or more categories to which the sets of instructions have been assigned.

4 more elements

Dependencies are inferred from the claim text.