METHOD AND COMPUTER PROGRAM PRODUCT FOR PROCESSING INSURANCE CLAIMS ACCORDING TO A PLURALITY OF RULES
A method and a computer program product are provided for processing an insurance claim. In particular, an example method may comprise receiving policy information associated with a particular insurance policy. The policy information may comprise a plurality of rules that define one or more benefits under the insurance policy. The example method may further comprise organizing the plurality of rules into a predefined tabular format. Furthermore, the example method may comprise providing a claims processing engine with the organized plurality of rules and thereafter processing the insurance claim in accordance with the plurality of rules.
1 . A method of processing an insurance claim, said method comprising:
receiving policy information associated with a particular insurance policy, wherein the policy information comprises a plurality of rules that define one or more benefits under the insurance policy;
organizing the plurality of rules into a predefined tabular format;
providing a claims processing engine with the organized plurality of rules; and
thereafter processing the insurance claim in accordance with the plurality of rules.
2 . The method of claim 1 , wherein organizing the plurality of rules into a predefined tabular format comprises organizing the rules into a table having one or more fields associated with respective one or more elements of the insurance policy.
3 . The method of claim 2 further comprising updating the table with one or more additional rules associated with the insurance policy.
4 . The method of claim 2 further comprising changing one or more of the rules by changing the contents of one or more fields of the table.
5 . The method of claim 1 , wherein processing the insurance claim comprises determining the benefit for which the party who submitted the insurance claim is eligible.
6 . The method of claim 5 , wherein processing the insurance claim further comprises determining whether a service associated with the insurance claim is covered by the insurance policy.
7 . The method of claim 6 , wherein processing the insurance claim further comprises determining whether a provider associated with the insurance claim is authorized to perform the service.
8 . The method of claim 1 further comprising providing the claims processing engine to a provider associated with the insurance claim for processing one or more insurance claims.
9 . The method of claim 2 , wherein processing the insurance claim further comprises extracting the rules from the table.
10 . The method of claim 2 , wherein the table applies to a plurality of insurance policies offered by one or more insurance providers.
11 . A computer program product for processing an insurance claim, wherein the computer program product comprises at least one computer-readable storage medium having computer-readable program code portions stored therein, the computer-readable program code portions comprising:
a first executable portion for receiving policy information associated with a particular insurance policy, wherein the policy information comprises a plurality of rules that define one or more benefits under the insurance policy;
a second executable portion for organizing the plurality of rules into a predefined tabular format;
a third executable portion for providing a claims processing engine with the organized plurality of rules; and
a fourth executable portion for thereafter processing the insurance claim in accordance with the plurality of rules.
12 . The computer program product of claim 11 , wherein the second executable portion for organizing the plurality of rules into a predefined tabular format is further configured to organize the rules into a table having one or more fields associated with respective one or more elements of the insurance policy.
13 . The computer program product of claim 12 further comprising:
a fifth executable portion for updating the table with one or more additional rules associated with the insurance policy.
14 . The computer program product of claim 12 further comprising:
a fifth executable portion for changing one or more of the rules by changing the contents of one or more fields of the table.
15 . The computer program product of claim 11 , wherein the fourth executable portion for processing the insurance claim is further configured to determine the benefit for which the party who submitted the insurance claim is eligible.
16 . The computer program product of claim 15 , wherein the fourth executable portion for processing the insurance claim is further configured to determine whether a service associated with the insurance claim is covered by the insurance policy.
17 . The computer program product of claim 16 , wherein the fourth executable portion for processing the insurance claim is further configured to determine whether a provider associated with the insurance claim is authorized to perform the service.
18 . The computer program product of claim 11 further comprising providing the claims processing engine to a provider associated with the insurance claim for processing one or more insurance claims.
19 . The computer program product of claim 12 , wherein processing the insurance claim further comprises extracting the rules from the table.
20 . The computer program product of claim 12 , wherein the table applies to a plurality of insurance policies offered by one or more insurance providers.