公开(公告)号：US08666787B2

公开(公告)日：2014-03-04

申请号：US13709141

申请日：2012-12-10

Applicant: TriZetto Corporation

Inventor： Mark Lesswing ,  Dale Hoerle

IPC: G06Q40/00

CPC classification number: G06F19/328 ,  G06Q10/10 ,  G06Q40/00 ,  G06Q40/04 ,  G06Q40/08 ,  G06Q50/22

Abstract: A method for repricing a reimbursement claim under at least one contract is provided herein. The method may include a combination of steps such as: converting each contract into a series of contractual terms; converting a claim into a series of claim lines, containing claim codes, unit numbers and corresponding charges for the claim codes; comparing claim codes and contractual terms and identifying matches therebetween; determining any priority conditions associated to the matching contractual terms, and eliminate any matching contractual terms that are excluded by the priority conditions; calculating the reimbursement amount for the claim by determining the reimbursement charges for the non-excluded matching contractual terms; and determining and making any adjustments depending upon any discount terms for the entire reimbursement amount.

Abstract translation: 本文提供了根据至少一项合同重新定价报销索赔的方法。 该方法可以包括步骤的组合，例如：将每个合同转换成一系列合同术语; 将索赔转为一系列索赔行，其中包含索赔代码，单位号码和索赔代码的相应费用; 比较索赔代码和合同条款，并确定其间的匹配; 确定与匹配合同条款相关联的任何优先级条件，并消除优先条件排除的任何匹配合同条款; 通过确定未排除的匹配合同条款的报销费用来计算索赔的报销金额; 并根据整个报销金额的任何折扣条件来确定和进行任何调整。

公开(公告)号：US20140067417A1

公开(公告)日：2014-03-06

申请号：US14079627

申请日：2013-11-13

Applicant: TriZetto Corporation

Inventor： Mark Lesswing ,  Dale Hoerle

IPC: G06F19/00

CPC classification number: G06F19/328 ,  G06Q10/10 ,  G06Q40/00 ,  G06Q40/04 ,  G06Q40/08 ,  G06Q50/22

Abstract: A method for repricing a reimbursement claim under at least one contract is provided herein. The method may include a combination of steps such as: converting each contract into a series of contractual terms; converting a claim into a series of claim lines, containing claim codes, unit numbers and corresponding charges for the claim codes; comparing claim codes and contractual terms and identifying matches therebetween; determining any priority conditions associated to the matching contractual terms, and eliminate any matching contractual terms that are excluded by the priority conditions; calculating the reimbursement amount for the claim by determining the reimbursement charges for the non-excluded matching contractual terms; and determining and making any adjustments depending upon any discount terms for the entire reimbursement amount.

Abstract translation: 本文提供了根据至少一项合同重新定价报销索赔的方法。 该方法可以包括步骤的组合，例如：将每个合同转换成一系列合同术语; 将索赔转为一系列索赔行，其中包含索赔代码，单位号码和索赔代码的相应费用; 比较索赔代码和合同条款，并确定其间的匹配; 确定与匹配合同条款相关联的任何优先级条件，并消除优先条件排除的任何匹配合同条款; 通过确定未排除的匹配合同条款的报销费用来计算索赔的报销金额; 并根据整个报销金额的任何折扣条件来确定和进行任何调整。