Systems and methods for claim processing
Systems and methods for dynamically scheduling a claim review are provided. A request to display an instance of a claim review is received, the request generated by a user in a plurality of users associated with a first or second entity. The instance of the claim review includes claims by a plurality of claimants, each claim associated with both the first and second entity. Responsive to the request, a customizable template specifying an order and subset of the claims in the instance of the claim review is applied. Each claim is accessed, in electronic form, from one or more data stores, to acquire a summary of the respective claim. A customizable user interface is displayed, including a completion status for the claim review, the summary of each claim, a first affordance for updating the completion status, and a second affordance for updating a criterion.
1 . A computer-implemented method for dynamically updating a customizable user interface, the computer-implemented method comprising:
at a real-time, interactive computer system comprising one or more processors, and a memory storing one or more programs for execution by the one or more processors, the one or more programs comprising one or more instructions for, for each respective user in a first plurality of users comprising at least 5,000 users:
receiving, in electronic form, via a network, by a network communication module of the real-time, interactive computer system, a request to access a structured data construct stored at the real-time, interactive computer system, wherein:
the request (i) is generated at a first remote device, in a plurality of remote devices, associated with a first user, in the first plurality of users, and (ii) comprises an identity of the first user,
the real-time, interactive computer system is communicatively coupled, via the network, to at least two remote devices, in the plurality of remote devices, comprising the first remote device,
each respective user in the first plurality of users is associated with (i) a first entity or a second entity and (ii) at least one remote device in the plurality of remote devices,
the structured data construct comprises an index of a corresponding plurality of data records unique to one or more users in the first plurality of users, the one or more users comprises the first user, and each respective data record in the corresponding plurality of data records corresponding to a plurality of criteria for a corresponding benefit for a different user in a second plurality of users that excludes the first plurality of users and generated by a respective remote device in the plurality of remote devices excluding the first remote device,
the second plurality of users comprises at least 50,000 users,
the corresponding plurality of data records comprises at least 40,000 data records, and
each data record in the corresponding plurality of data records is associated with (i) both the first entity and the second entity, and (ii) the one or more users in the first plurality of users;
responsive to the request, performing a process in real time, the process comprising:
retrieving, responsive to authenticating the identity of the first user, from a customizable template construct of the real-time, interactive computer system storing a plurality of customizable templates, a first customizable template defined by the first user, wherein each respective customizable template specifies a user-defined visualization of a respective plurality of data records in accordance with (i) an independent set of affordances defined by a corresponding user, each respective affordance in the independent set of affordances configured (a) by the first user for performing one or more actions to a corresponding data entry of a data record and (b) to display concurrently with each affordance in the independent set of affordances, (ii) an ordered listing of candidate data records specified by one or more filtering criteria, and (iii) a subset of the corresponding plurality of data records;
accessing, responsive to the first customizable template, in electronic form, from the structured data construct of the real-time, interactive computer system, each respective data record in the corresponding plurality of data records, to acquire a real-time record of a corresponding plurality of data entries associated with the respective data record, wherein the corresponding plurality of data entries comprises (i) a first data entry associated with a completion status of the respective data record, (ii) a second data entry associated with an elapsed time during a period of time allocated to the respective data record, the period of time defined a corresponding threshold timeline for a corresponding user in the second plurality of users, and (iii) a plurality of annotations comprising a first annotation associated with the corresponding user, in the second plurality of users, and authored by the first user, in the first plurality of users, and a second annotation associated with the corresponding user and authored by a second user in a third plurality of users different from both the first plurality of users user and the second plurality of users;
evaluating, by the one or more processors of the real-time, interactive computer system, for each respective data record in the corresponding plurality of data records, each data entry in the corresponding plurality of data entries, thereby generating, without human interference, a summary of the respective data record;
applying the first customizable template to the real-time record of the plurality of data records, thereby generating, by the one or more processors of the real-time, interactive computer system, one or more instructions for displaying a customizable user interface, the customizable user interface comprising:
(i) a first affordance, in the independent set of affordances, for visualizing a graphical representation of the completion status for the corresponding plurality of data records,
(ii) for each respective data record in the corresponding plurality of data records, a corresponding second affordance, in the independent set of affordances, for visualizing the summary of the respective data record,
(iii) a third affordance, in the independent set of affordances, for updating, the completion status of the corresponding plurality of data records using a first graphical element of the third affordance, and
(iv) a fourth affordance, in the independent set of affordances, for updating a criterion for deeming complete some or all of the corresponding plurality of data records using a second graphical element of the fourth affordance;
communicating, via the network, by the network communication module of the real-time, interactive computer system, the one or more instructions for displaying the customizable user interface, thereby causing presentation of the customizable user interface at the display of the first remote device; and
further receiving, in electronic form, via the network, by the network communication module of the real-time, interactive computer system, a selection of the first graphical element of the third affordance or the second graphical element of the fourth affordance, wherein the selection is generated at the first remote device via an input by the user at the first remote device, and wherein
upon selection of the first graphical element of the third affordance, updating (i), at the structured data construct, the corresponding plurality of data records by modifying the first data entry in the corresponding plurality of data entries associated with the completion status of a first data record in the corresponding plurality of data records and (ii) the graphical representation of the completion status for the corresponding plurality of data records, and
upon selection of the second graphical element of the fourth affordance, updating (i), at the structured data construct, the corresponding plurality of data records by updating the second data entry in the corresponding plurality of data entries associated with the criterion for deeming complete some or all of the corresponding plurality of data records and (ii) the graphical representation of the completion status for the corresponding plurality of data records in accordance with an approval of the updating (i) from at least a third user, in the first plurality of users, associated with the first entity and a fourth user, in the first plurality of users, associated with the second entity other than the first user or the second user.
2 . The method of claim 1 , wherein the completion status for the corresponding plurality of data records is selected from the group consisting of: initiated, preparation, complete, submit for review, finalize, and schedule.
3 . The method of claim 1 , wherein the criterion for deeming complete some or all of the corresponding plurality of data records is a program discussion topic.
4 . The method of claim 1 , wherein the criterion for deeming complete some or all of the corresponding plurality of data records is a claim type for the one or more data records in the corresponding plurality of data records.
5 . The method of claim 1 , wherein the customizable user interface further comprises a fifth affordance, in the independent set of affordances, for selecting, by the first user, a review schedule, and wherein the method further comprises, upon user selection of the fifth affordance, assigning a review schedule to the corresponding plurality of data records, thereby scheduling completion of the claim review before elapsing of the period of time.
6 . The method of claim 1 , wherein the customizable user interface further comprises a sixth affordance, in the independent set of affordances, for visualizing a review date for the corresponding plurality of data records.
7 . The method of claim 1 , wherein the customizable user interface further comprises a seventh affordance, in the independent set of affordances, for visualizing a historical record for the corresponding plurality of data records.
8 . The method of claim 7 , further comprising, upon user selection of the seventh affordance, displaying one or more revisions, by the first user, the second user, the third user or the fourth to the corresponding plurality of data records.
9 . The method of claim 1 , wherein the customizable user interface further comprises an eighth affordance, in the independent set of affordances, for modifying, by the first user, an annotation in the plurality of annotations.
10 . The method of claim 1 , wherein the customizable user interface further comprises a ninth affordance, in the independent set of affordances, for modifying, by the first user, the corresponding plurality of data records.
11 . The method of claim 10 , further comprising, upon user selection of the ninth affordance, updating, at the claim review module, the corresponding plurality of data records by modifying at least two data entries of the first data record.
12 . The method of claim 10 , wherein the modifying comprises adding a data entry, removing a data entry, updating a status corresponding to a respective data entry, recording a personnel change for a respective data entry, updating a feature for a respective data entry, or a combination thereof.
13 . The method of claim 1 , wherein the customizable user interface further comprises, for each respective data record in the one or more claims for the corresponding plurality of data records, a corresponding respective affordance for expanding, by the first user, the summary of the respective data record to an expanded summary of the respective data record, wherein the expanded summary of the respective data record is based on a corresponding one or more data entries of the respective data record not displayed prior to the expanding.
14 . The method of claim 1 , further comprising receiving a request to generate the real-time record of the corresponding plurality of data entries associated with the respective data record by:
applying a second customizable template to the corresponding plurality of data entries, wherein the second customizable template specifies a subset of candidate data entries in a plurality of candidate data entries associated with both the first and the second entity, thereby obtaining one or more candidate data entries, and
adding the one or more candidate data entries to the the corresponding plurality of data entries.
15 . The method of claim 14 , further comprising, prior to the adding the one or more candidate data entries to the the corresponding plurality of data entries, obtaining an approval of the one or more candidate data entries from at least the third user associated with the first entity and the fourth user associated with the second entity other than the first user or the second user.
16 . The method of claim 1 , wherein the the corresponding plurality of data entries is accessed by the first user at the first remote device.
17 . The method of claim 1 , wherein the customizable user interface further comprises an exporting affordance for exporting the the corresponding plurality of data entries.
18 . The method of claim 1 , further comprising generating a report comprising the the corresponding plurality of data entries.
19 . The method of claim 1 , wherein the customizable user interface further displays, for each respective data record, an indication of one or more users in the second plurality of users or the third plurality of users assigned to the review date for the the corresponding plurality of data entries.
20 . The method of claim 1 , wherein the receiving further comprises:
receiving log-in credentials for the first user; and
detecting selection, by the first user, of a respective data entry.
21 . A real-time, interactive computer system, comprising one or more processors and memory, the memory storing instructions for performing a method comprising:
receiving, in electronic form, via a network, by a network communication module of the real-time, interactive computer system, a request to access a structured data construct stored at the real-time, interactive computer system, wherein:
the request (i) is generated at a first remote device, in a plurality of remote devices, associated with a first user, in the first plurality of users, and (ii) comprises an identity of the first user,
the real-time, interactive computer system is communicatively coupled, via the network, to at least two remote devices, in the plurality of remote devices, comprising the first remote device,
each respective user in the first plurality of users is associated with (i) a first entity or a second entity and (ii) at least one remote device in the plurality of remote devices,
the structured data construct comprises an index of a corresponding plurality of data records unique to one or more users in the first plurality of users, the one or more users comprises the first user, and each respective data record in the corresponding plurality of data records corresponding to a plurality of criteria for a corresponding benefit for a different user in a second plurality of users that excludes the first plurality of users and generated by a respective remote device in the plurality of remote devices excluding the first remote device,
the second plurality of users comprises at least 50,000 users,
the corresponding plurality of data records comprises at least 40,000 data records, and
each data record in the corresponding plurality of data records is associated with (i) both the first entity and the second entity, and (ii) the one or more users in the first plurality of users;
responsive to the request, performing a process in real time, the process comprising:
retrieving, responsive to authenticating the identity of the first user, from a customizable template construct of the real-time, interactive computer system storing a plurality of customizable templates, a first customizable template defined by the first user, wherein each respective customizable template specifies a user-defined visualization of a respective plurality of data records in accordance with (i) an independent set of affordances defined by a corresponding user, each respective affordance in the independent set of affordances configured (a) by the first user for performing one or more actions to a corresponding data entry of a data record and (b) to display concurrently with each affordance in the independent set of affordances, (ii) an ordered listing of candidate data records specified by one or more filtering criteria, and (iii) a subset of the corresponding plurality of data records;
accessing, responsive to the first customizable template, in electronic form, from the structured data construct of the real-time, interactive computer system, each respective data record in the corresponding plurality of data records, to acquire a real-time record of a corresponding plurality of data entries associated with the respective data record, wherein the corresponding plurality of data entries comprises (i) a first data entry associated with a completion status of the respective data record, (ii) a second data entry associated with an elapsed time during a period of time allocated to the respective data record, the period of time defined a corresponding threshold timeline for a corresponding user in the second plurality of users, and (iii) a plurality of annotations comprising a first annotation associated with the corresponding user, in the second plurality of users, and authored by the first user, in the first plurality of users, and a second annotation associated with the corresponding user and authored by a second user in a third plurality of users different from both the first plurality of users user and the second plurality of users;
evaluating, by the one or more processors of the real-time, interactive computer system, for each respective data record in the corresponding plurality of data records, each data entry in the corresponding plurality of data entries, thereby generating, without human interference, a summary of the respective data record;
applying the first customizable template to the real-time record of the plurality of data records, thereby generating, by the one or more processors of the real-time, interactive computer system, one or more instructions for displaying a customizable user interface, the customizable user interface comprising:
(i) a first affordance, in the independent set of affordances, for visualizing a graphical representation of the completion status for the corresponding plurality of data records,
(ii) for each respective data record in the corresponding plurality of data records, a corresponding second affordance, in the independent set of affordances, for visualizing the summary of the respective data record,
(iii) a third affordance, in the independent set of affordances, for updating, the completion status of the corresponding plurality of data records using a first graphical element of the third affordance, and
(iv) a fourth affordance, in the independent set of affordances, for updating a criterion for deeming complete some or all of the corresponding plurality of data records using a second graphical element of the fourth affordance;
communicating, via the network, by the network communication module of the real-time, interactive computer system, the one or more instructions for displaying the customizable user interface, thereby causing presentation of the customizable user interface at the display of the first remote device; and
further receiving, in electronic form, via the network, by the network communication module of the real-time, interactive computer system, a selection of the first graphical element of the third affordance or the second graphical element of the fourth affordance, wherein the selection is generated at the first remote device via an input by the user at the first remote device, and wherein
upon selection of the first graphical element of the third affordance, updating (i), at the structured data construct, the corresponding plurality of data records by modifying the first data entry in the corresponding plurality of data entries associated with the completion status of a first data record in the corresponding plurality of data records and (ii) the graphical representation of the completion status for the corresponding plurality of data records, and
upon selection of the second graphical element of the fourth affordance, updating (i), at the structured data construct, the corresponding plurality of data records by updating the second data entry in the corresponding plurality of data entries associated with the criterion for deeming complete some or all of the corresponding plurality of data records and (ii) the graphical representation of the completion status for the corresponding plurality of data records in accordance with an approval of the updating (i) from at least a third user, in the first plurality of users, associated with the first entity and a fourth user, in the first plurality of users, associated with the second entity other than the first user or the second user.
22 . A non-transitory computer-readable medium storing one or more computer programs, executable by a real-time, interactive computer system, for performing a method, interactive computer system comprising one or more processors and a memory, the one or more computer programs collectively encoding computer executable instructions that perform the method comprising:
receiving, in electronic form, via a network, by a network communication module of the real-time, interactive computer system, a request to access a structured data construct stored at the real-time, interactive computer system, wherein:
the request (i) is generated at a first remote device, in a plurality of remote devices, associated with a first user, in the first plurality of users, and (ii) comprises an identity of the first user,
the real-time, interactive computer system is communicatively coupled, via the network, to at least two remote devices, in the plurality of remote devices, comprising the first remote device,
each respective user in the first plurality of users is associated with (i) a first entity or a second entity and (ii) at least one remote device in the plurality of remote devices,
the structured data construct comprises an index of a corresponding plurality of data records unique to one or more users in the first plurality of users, the one or more users comprises the first user, and each respective data record in the corresponding plurality of data records corresponding to a plurality of criteria for a corresponding benefit for a different user in a second plurality of users that excludes the first plurality of users and generated by a respective remote device in the plurality of remote devices excluding the first remote device,
the second plurality of users comprises at least 50,000 users,
the corresponding plurality of data records comprises at least 40,000 data records, and
each data record in the corresponding plurality of data records is associated with (i) both the first entity and the second entity, and (ii) the one or more users in the first plurality of users;
responsive to the request, performing a process in real time, the process comprising:
retrieving, responsive to authenticating the identity of the first user, from a customizable template construct of the real-time, interactive computer system storing a plurality of customizable templates, a first customizable template defined by the first user, wherein each respective customizable template specifies a user-defined visualization of a respective plurality of data records in accordance with (i) an independent set of affordances defined by a corresponding user, each respective affordance in the independent set of affordances configured (a) by the first user for performing one or more actions to a corresponding data entry of a data record and (b) to display concurrently with each affordance in the independent set of affordances, (ii) an ordered listing of candidate data records specified by one or more filtering criteria, and (iii) a subset of the corresponding plurality of data records;
accessing, responsive to the first customizable template, in electronic form, from the structured data construct of the real-time, interactive computer system, each respective data record in the corresponding plurality of data records, to acquire a real-time record of a corresponding plurality of data entries associated with the respective data record, wherein the corresponding plurality of data entries comprises (i) a first data entry associated with a completion status of the respective data record, (ii) a second data entry associated with an elapsed time during a period of time allocated to the respective data record, the period of time defined a corresponding threshold timeline for a corresponding user in the second plurality of users, and (iii) a plurality of annotations comprising a first annotation associated with the corresponding user, in the second plurality of users, and authored by the first user, in the first plurality of users, and a second annotation associated with the corresponding user and authored by a second user in a third plurality of users different from both the first plurality of users user and the second plurality of users;
evaluating, by the one or more processors of the real-time, interactive computer system, for each respective data record in the corresponding plurality of data records, each data entry in the corresponding plurality of data entries, thereby generating, without human interference, a summary of the respective data record;
applying the first customizable template to the real-time record of the plurality of data records, thereby generating, by the one or more processors of the real-time, interactive computer system, one or more instructions for displaying a customizable user interface, the customizable user interface comprising:
(i) a first affordance, in the independent set of affordances, for visualizing a graphical representation of the completion status for the corresponding plurality of data records,
(ii) for each respective data record in the corresponding plurality of data records, a corresponding second affordance, in the independent set of affordances, for visualizing the summary of the respective data record,
(iii) a third affordance, in the independent set of affordances, for updating, the completion status of the corresponding plurality of data records using a first graphical element of the third affordance, and
(iv) a fourth affordance, in the independent set of affordances, for updating a criterion for deeming complete some or all of the corresponding plurality of data records using a second graphical element of the fourth affordance;
communicating, via the network, by the network communication module of the real-time, interactive computer system, the one or more instructions for displaying the customizable user interface, thereby causing presentation of the customizable user interface at the display of the first remote device; and
further receiving, in electronic form, via the network, by the network communication module of the real-time, interactive computer system, a selection of the first graphical element of the third affordance or the second graphical element of the fourth affordance, wherein the selection is generated at the first remote device via an input by the user at the first remote device, and wherein
upon selection of the first graphical element of the third affordance, updating (i), at the structured data construct, the corresponding plurality of data records by modifying the first data entry in the corresponding plurality of data entries associated with the completion status of a first data record in the corresponding plurality of data records and (ii) the graphical representation of the completion status for the corresponding plurality of data records, and
upon selection of the second graphical element of the fourth affordance, updating (i), at the structured data construct, the corresponding plurality of data records by updating the second data entry in the corresponding plurality of data entries associated with the criterion for deeming complete some or all of the corresponding plurality of data records and (ii) the graphical representation of the completion status for the corresponding plurality of data records in accordance with an approval of the updating (i) from at least a third user, in the first plurality of users, associated with the first entity and a fourth user, in the first plurality of users, associated with the second entity other than the first user or the second user.
23 . The method of claim 1 , wherein the second affordance is displayed as a list, a calendar, or a schedule.
24 . The method of claim 1 , wherein the customizable user interface further comprises a tenth affordance for visualizing the index of of the corresponding plurality of data records.
25 . The method of claim 1 , wherein each affordance in the independent set of affordances is displayed concurrently via the customizable user interface.
26 . The method of claim 1 , wherein the customizable user interface is configured to transition between a first of affordances and a second set of affordances.
27 . The method of claim 1 , the first customizable template is unique to the first user.
28 . The method of claim 1 , wherein the process is performed without human interference.