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US 8,346,577 B2Granted
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.
Claims16
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;
- using the processor, accepting or rejecting each auditable item based on the item identifier and one or more rules associated with the data file;
- unsuccessfully associating a translated item description with a single item identifier;
- and
- associating the translated item description with a plurality of item identifiers.
5 more elements
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;
- wherein translating the word string comprises:
- 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.
6 more elements
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;
- wherein translating the word string comprises:
- determining word string comprises one or more specific words from a plurality of specific words;
- and for each specific word from the one or more specific words, processing the word string based on the specific word.
6 more elements
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;
- wherein translating the word string comprises:
- determining the word string comprises one or more abbreviations from a plurality of abbreviations;
- and for each abbreviation from the one or more abbreviations, processing the word string based on the abbreviation.
6 more elements
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;
- using the processor, accepting or rejecting each auditable item based on the item identifier and one or more rules associated with the data file;
- and for each predetermined item:
- determining whether the word string satisfies a condition associated with the predetermined item;
- and
- if the word string satisfies the condition, generating the translated item description;
- 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.
11 more elements
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,
- 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, and
- wherein comparing comprises, for each word in the word string:
- determining whether the word is an orientation word;
- if the word is an orientation word, modifying the word string based on the orientation word;
- if the word is not an orientation word:
- determining whether one or more remaining words in the word string match a list of preceding terms;
- for each word that matches the list of preceding terms, recording a preceding relationship;
- determining whether one or more remaining words in the word string match a list of anteceding terms;
- and
- for each word that matches the list of anteceding terms, recording an anteceding relationship.
17 more elements
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;
- using the processor, accepting or rejecting each auditable item based on the item identifier and one or more rules associated with the data file;
- determining at least one word of the word string is not associated with a relationship;
- and
- processing one or more non-orientation words of the word string,
- 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.
10 more elements
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,
- 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, and
- wherein the one or more predetermined items comprise one or more punctuation marks, one or more joinable words, or any combination thereof.
9 more elements
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,
- wherein:
- the data file comprises an automobile insurance demand file;
- and
- the one or more word strings comprise one or more repair part descriptions.
7 more elements
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, wherein the auditable items include one or more operational items, the one or more operational items including an identity of an operational item that does not involve replacement of a vehicle part.
3 more elements
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, wherein the accepting includes automatically approving part selections on behalf of an insurer, and documenting historical parts availability for subrogation reviewers.
3 more elements
Dependencies are inferred from the claim text.