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US 2013/0006614 A1Published application
Automation of auditing claims
AssigneeHyperQuest, Inc.
InventorsDennis M. Hogan, Jeffrey J. Hogan
Life of this patent
Estimating the term…
Abstract
Described are computer-based methods and apparatuses, including computer program products, for automation of auditing claims. A data file is received comprising one or more auditable items, each auditable item comprising a word string having one or more words. Each word string for each auditable item is translated using one or more translation steps into a translated item description. Each translated item description is compared to a plurality of terms to generate matching information. Each translated item description is associated with an item identifier based on the matching information. Each auditable item is accepted or rejected based on the item identifier and one or more rules associated with the data file.
Claims42
A computerized auditing method comprising:
- receiving, via a processor, a data file comprising one or more auditable items, each auditable item being a line item from an insurance claim file, where each auditable item comprises a word string having one or more words;
- translating, using the processor, each word string for each auditable item using one or more translation steps into a translated item description;
- comparing, using the processor, each translated item description to a plurality of terms to generate matching information;
- associating, using the processor, each translated item description with an item identifier based on the matching information;
- and
- using the processor, accepting or rejecting each auditable item based on the item identifier and one or more rules associated with the data file.
3 more elements
(canceled)
A computerized auditing method comprising:
- translating, using a processor, a word string of an auditable item using one or more translation steps into a translated item description, wherein the one or more translation steps include determining the word string comprises one or more standard words from a plurality of standard words and removing the one or more standard words from the word string, and wherein the auditable item is a line item from an insurance claim file;
- and
- using the processor, accepting or rejecting the auditable item based on the translating.
A computerized auditing method comprising:
- translating, using a processor, a word string of an auditable item using one or more translation steps into a translated item description, wherein the one or more translation steps include determining the word string comprises one or more specific words from a plurality of specific words and removing the one or more specific words from the word string, and wherein the auditable item is a line item from an insurance claim file;
- and
- using the processor, accepting or rejecting the auditable item based on the translating.
A computerized auditing method comprising:
- translating, using a processor, a word string of an auditable item using one or more translation steps into a translated item description, wherein the one or more translation steps include determining the word string comprises one or more abbreviations from a plurality of abbreviations and for each of the one or more abbreviations processing the word string based on the abbreviations, and wherein the auditable item is a line item from an insurance claim file;
- and
- using the processor, accepting or rejecting the auditable item based on the translating.
A computerized auditing method comprising:
- translating, using a processor, a word string of an auditable item using one or more translation steps into a translated item description, wherein the auditable item is a line item from an insurance claim file;
- and
- using the processor, accepting or rejecting the auditable item based on the translating, wherein translating the word string comprises:
- applying one or more rules from a plurality of rules to the word string, wherein each rule is associated with a logic for processing the word string;
- determining whether the word string contains one or more predetermined items;
- and
- if the word string contains one or more predetermined items, for each predetermined item, processing the word string based on the predetermined item.
4 more elements
A computerized auditing method comprising:
- translating, using a processor, a word string of an auditable item using one or more translation steps into a translated item description, wherein the auditable item is a line item from an insurance claim file;
- and
- using the processor, accepting or rejecting the auditable item based on the translating, wherein translating the word string comprises:
- applying one or more combination rules to the word string, wherein each rule is associated with a logic for processing the word string;
- comparing the word string against a build table to generate a relationship between words of the word string, the build table comprising one or more index words, each index word being associated with index information;
- and
- generating the translated item description based on the relationship.
4 more elements
29-37. (canceled)
A computerized auditing method comprising:
- translating, using a processor, a word string of an auditable item using one or more translation steps into a translated item description, wherein the auditable item is a line item from an insurance claim file;
- and
- using the processor, accepting or rejecting the auditable item based on the translating, wherein the accepting includes automatically approving part selections on behalf of an insurer.
A computerized auditing method comprising:
- receiving, via a processor, a data file comprising one or more auditable items, each auditable item being a line item from an insurance claim file, where each auditable item comprises a word string having one or more words;
- translating, using the processor, each word string for each auditable item using one or more translation steps into a translated item description, including automatically translating an operational item from the one or more auditable items, the operational item being an auditable item that does not involve a physical removal of a vehicle part or replacement of a vehicle part with a replacement part;
- associating, using the processor, each translated item description with an item identifier;
- and
- using the processor, accepting or rejecting each auditable item based on the item identifier and one or more rules associated with the data file.
2 more elements
A computerized auditing method comprising:
- receiving, via a processor, an insurance data file comprising one or more auditable items, each auditable item comprising a word string having one or more words;
- translating, using the processor, each word string for each auditable item using one or more translation steps into a translated item description, including automatically translating an operational item from the one or more auditable items, the operational item being an auditable item that does not involve replacement of a vehicle part with a replacement part;
- associating, using the processor, each translated item description with an item identifier;
- and
- using the processor, accepting an auditable item based on the item identifier and one or more rules associated with the data file.
2 more elements
A computerized vehicle insurance auditing system comprising:
- a processor coupled to a nontransitory computer readable storage medium having stored therein software instructions that, when executed by the processor, cause the processor to perform a series of operations including:
- receiving, via the processor, a data file comprising one or more auditable items, each auditable item being a line item from an insurance claim file, each auditable item comprising a word string having one or more words;
- translating, using the processor, each word string for each auditable item using one or more translation steps into a translated item description;
- associating, using the processor, each translated item description with an item identifier;
- and
- using the processor, automatically determining whether to accept or reject each auditable item based on the item identifier and one or more rules associated with the data file.
3 more elements
A nontransitory computer readable storage medium having stored therein software instructions that, when executed by a processor, cause the processor to perform a series of operations including:
- receiving an insurance data file comprising one or more auditable items, each auditable item comprising a word string having one or more words;
- translating each word string for each auditable item using one or more translation steps into a translated item description;
- comparing each translated item description to a plurality of terms to generate matching information;
- associating each translated item description with an item identifier based on the matching information;
- and
- determining whether to accept or reject each auditable item based on the item identifier and one or more rules associated with the data file.
3 more elements
Dependencies are inferred from the claim text.