Adjudication platform compliance management
AssigneeInternational Business Machines Corporation
InventorsAharon Abadi, Jonathan Bnayahu, Moti Nisenson
Life of this patent
Estimating the term…
Abstract
A method of verifying compliance of an adjudication platform with a requirement, the method comprising: applying a requirement to an adjudication platform, wherein said adjudication platform comprises a plurality of benefit rules and said requirement comprises a plurality of requirements representing at least one of a law and an insurance policy; identifying at least one of said plurality of benefit rules disagreeing with at least one of said plurality of requirements, responsive to a discrepancy between applied said requirement and said adjudication platform; outputting at least one of identified said plurality of benefit rules and said plurality of requirements.
Claims23
A computerized method of verifying compliance of a plurality of benefit rules with a plurality of requirements, said method comprising:
- acquiring a plurality of benefit rules of an adjudication platform;
- applying a plurality of requirements representing at least one of a law and an insurance policy to said plurality of benefit rules;
- identifying at least one of said plurality of benefit rules disagreeing with at least one of said plurality of requirements, responsive to a discrepancy between applied plurality of requirements and said plurality of benefit rules;
- outputting at least one of identified said plurality of benefit rules and said plurality of requirements.
A computerized method of verifying self consistency of an adjudication platform, the method comprising:
- assigning at least one of a plurality of formulas and a plurality of eligibility characteristics to a plurality of benefit rules representing an adjudication platform;
- identifying a fault in at least one of said plurality of benefit rules, said fault comprising:
- a contradiction between said plurality of benefit rules, repetition of a benefit rule, a benefit rule which is always true, a benefit rule which is always false and a benefit rule which is never assessed.
A computer program product for verifying compliance of a plurality of benefit rules with a plurality of requirements, comprising:
- a computer readable storage medium;
- first program instructions to apply a plurality of requirements to plurality of benefit rules;
- second program instructions to identify a discrepancy between applied said plurality of requirements and said plurality of benefit rules;
- and
- third program instructions to output said discrepancy;
- wherein said first, second and third program instructions are stored on said computer readable storage medium.
A system for verifying compliance of a plurality of benefit rules with a plurality of requirements, said system comprising:
- a processor;
- a calculation module which, using said processor, applies a plurality of requirements to a plurality of benefit rules, wherein said calculation module identifies at least one of said plurality of benefit rules disagreeing with at least one of said plurality of requirements;
- and
- an interface module which acquires said plurality of benefit rules, acquires said plurality of requirements, and outputs identified disagreeing at least one of said plurality of benefit rules.
Dependencies are inferred from the claim text.