Systems and Methods for Benefit Plan Management in Accordance with Captured User Intent
A system for providing end-to-end traceable benefit plans includes an intake engine configured to generate, from input source data, a plurality of benefit plan components having one or more cross-dependencies with respect to each other, wherein the benefit plan components include: data structures reflecting benefit plan aspects and associated rules for implementation with respect to the benefit plan. The system includes an intake dashboard configured to intake the input source data provided by a user via the intake dashboard, the input source data capturing user intent with respect to benefit plan design and/or configuration. The system includes an extractor configured to extract the input source data from source systems, and an assembly module configured to assemble a benefit plan file from the benefit plan components, the benefit plan file associating benefit components with and across workflows and systems. The system includes a claims processing IT environment configured to load the benefit plan file, and to process claims in accordance with the benefit plan file.
1 . A system for providing end-to-end traceable benefit plans, the system comprising:
an intake engine configured to generate, from input source data, a plurality of benefit plan components having one or more cross-dependencies with respect to each other, wherein the benefit plan components include: data structures reflecting benefit plan aspects and associated rules for implementation with respect to the benefit plan;
an intake dashboard configured to intake the input source data provided by a user via the intake dashboard, the input source data capturing user intent with respect to benefit plan design and/or configuration;
an extractor configured to extract the input source data from source systems;
an assembly module configured to assemble a benefit plan file from the benefit plan components, the benefit plan file associating benefit components with and across workflows and systems; and
a claims processing IT environment configured to load the benefit plan file, and to process claims in accordance with the benefit plan file.
2 . The system of claim 1 , wherein the benefit plan is a formulary.
3 . The system of claim 1 , wherein the input source data includes historical benefit plan data.
4 . The system of claim 1 , wherein the association of benefit components includes associating benefit components to other components, functions, transactions and/or services called by the benefit component within the benefit plan.
5 . The system of claim 1 , wherein the claims processing IT environment is a virtual staging environment.
6 . The system of claim 1 , wherein the claims processing IT environment is configured to provide a report that analyzes benefit plan component impact on and/or implications for the benefit plan.
7 . The system of claim 1 , wherein the benefit plan components include at least: copays, formularies, networks, accumulators, and associated rules for respective implementation in the benefit plan.
8 . The system of claim 1 , wherein the assembly module is configured to generate the benefit components from historical benefit components.
9 . A method for providing end-to-end traceable benefit plans, the method comprising:
receiving input source data provided by a user via an intake dashboard, the input source data capturing user intent with respect to benefit plan design and/or configuration;
extracting, via an extractor, input source data from source systems;
generating, via an intake engine and from the input source data, a plurality of benefit plan components having one or more cross-dependencies with respect to each other, wherein the benefit plan components include: data structures reflecting benefit plan aspects and associated rules for implementation with respect to the benefit plan;
assembling, via an assembly module, a benefit plan file from the benefit plan components, the benefit plan file associating benefit components with and across workflows and systems; and
loading the benefit plan file into a claims processing IT environment for processing claims in accordance therewith.
10 . The method of claim 9 , wherein the benefit plan is a formulary.
11 . The method of claim 9 , wherein the input source data includes historical benefit plan data.
12 . The method of claim 9 , wherein the association of benefit components includes associating benefit components to other components, functions, transactions and/or services called by the benefit component within the benefit plan.
13 . The method of claim 9 , wherein the claims processing IT environment is a virtual staging environment.
14 . The method of claim 9 , wherein the claims processing IT environment is configured to provide a report that analyzes benefit plan component impact on and/or implications for the benefit plan.
15 . The method of claim 9 , wherein the benefit plan components include at least: copays, formularies, networks, accumulators, and associated rules for respective implementation in the benefit plan.
16 . The method of claim 9 , wherein the assembly module is configured to generate the benefit components from historical benefit components.