Granted Patent B2

US 12,237,077 · App. 17/702,325 · Granted Feb 25, 2025

Inventors: Leo P. Anthony (Phoenixville, PA); Kathleen M. Collins (Coatesville, PA); Asheesh Nadkarni (Lansdale, PA); Jaqulin N. Maria Sebastian (Malvern, PA); Hiral Shah (Ellicott City, MD)

Assignee: CERNER INNOVATION, INC.

G16H40/20G06F16/25

Abstract

Claims (52)

1. One or more non-transitory computer storage media storing computer-useable instructions that, when executed by a computing device, cause the computing device to perform operations, the operations comprising: receiving a request for causing generation of an Electronic Data Interchange (EDI) 835 transmission; providing a user interface on a display device of the computing device, wherein the user interface includes a plurality of input fields for selecting one or more data sources of claims data and for inputting test data; extracting from the one or more data sources selected, via a network, a plurality of historical EDI transmissions of claims data that include a plurality of different data formats; formatting the plurality of different data formats of the plurality of historical EDI transmissions of claims data into a predetermined 835 transmission format standard; electronically generating, via one or more processors, a merged EDI 835 transmission from the 835 transmission format standard of the plurality of historical EDI transmissions of claims data, wherein the merged EDI 835 transmission is generated using the claims data and inserting the test data from the user interface to trigger application of a particular rule from an 835 processing system; submitting, via network communication, the merged EDI 835 transmission to the 835 processing system for testing performance of the particular rule with the claims data and the test data prior to live implementation; electronically testing, via the one or more processors, the particular rule of the 835 processing system using the merged EDI 835 transmission as input; and based on the electronically testing, electronically determining, via the one or more processors to modify the performance and increase a processing power of the 835 processing system.

2. The one or more non-transitory computer storage media of claim 1 , wherein the test data includes implementation adjustment data.

3. The one or more non-transitory computer storage media of claim 1 , wherein one or more provider remarks are included in the test data and included in the merged EDI 835 transmission.

4. The one or more non-transitory computer storage media of claim 1 , wherein the test data includes copay data.

5. The one or more non-transitory computer storage media of claim 1 , wherein the claims data used to generate the merged EDI 835 transmission includes service rendered, provider information, and a code corresponding to the service rendered.

6. The one or more non-transitory computer storage media of claim 1 , wherein the test data corresponds to one or more rules for handling EDI 835transmissions.

7. A computer-implemented method for electronically generating an Electronic Data Interchange (EDI) 835 transmission, the method comprising:

detecting a selection associated with causing a generation of one or more EDI 835 transmissions;

identifying a first claim and a second claim from a plurality of claims, each of the plurality of claims having associated claims data, wherein first claim and the second claim are from different sources and have different data formats;

generating a first EDI 835 transmission by formatting the claims data of the first claim and inserting test data;

generating a second EDI 835 transmission by formatting the claims data of the second claim and inserting the test data;

generating a merged EDI 835 transmission by merging the first EDI 835 transmission and the second EDI 835 transmission together, wherein the merged EDI 835 transmission is formatted to a predetermined 835 transmission format standard;

submitting, via network communication, the merged EDI 835 transmission to an 835 processing system for testing performance of the 835 processing system prior to live implementation to test a runtime environment of the 835 processing system; and

based on the electronically testing, electronically determining, via one or more processors, to modify performance and increase a processing power of the 835 processing system.

8. The method of claim 7 , wherein the selection includes selecting a database that stores the plurality of claims each having a claim type, a claim date or claim date range, and provider information.

9. The method of claim 7 , wherein the first EDI 835 transmission is a first transmission type and the second EDI 835 transmission is a second transmission type that is different than the first transmission type, and wherein the method further comprises:

creating a first header for the first EDI 835 transmission;

creating a second header that is different than the first header for the second EDI 835 transmission; and

generating a merged header for the merged EDI 835 transmission using the first header and the second header.

10. The method of claim 9 , wherein the merged EDI 835 transmission is generated to include the first transmission type and the second transmission type.

11. The method of claim 7 , wherein the merged EDI 835 transmission includes provider remarks and provider adjustments, each associated with the first claim.

12. The method of claim 11 , wherein the merged EDI 835transmission includes provider remarks and provider adjustments, each associated with the second claim.

13. The method of claim 7 , wherein the test data triggers application of a particular rule that tests the particular rule in the 835 processing system, and wherein the method further comprises:

electronically testing, via one or more processors of the 835 processing system, the particular rule of the 835 processing system using the merged EDI 835 transmission as input; and

based on electronically testing, determining, via the one or more processors, a particular modification associated with performance of the 835processing system.

14. The method of claim 7 , the method further comprising:

generating the first EDI 835 transmission by inserting a first set of test data that triggers testing of one or more existing rules for a first entity for testing performance of the one or more existing rules for the first entity; and

generating the second EDI 835 transmission by inserting a second set of test data that triggers testing of one or more existing rules for a second entity for testing performance of the one or more existing rules for the second entity, wherein the second entity is different than the first entity;

wherein the merged EDI 835 transmission includes the first set of test data and the second set of test data.

15. The method of claim 7 , the method further comprising:

calculating a total number of lines for the merged EDI 835 transmission, wherein the total number of lines is an aggregation of a plurality of lines from the first EDI 835 transmission with a plurality of lines from the second EDI 835 transmission.

16. A computer system comprising:

one or more processors; and

one or more computer storage media storing computer-useable instructions that, when used by the one or more processors, cause the one or more processors to:

receive a request for causing generation of one or more Electronic Data Interchange (EDI) 835 transmissions;

provide a user interface on a display device of the computer system, wherein the user interface includes a plurality of input fields for at least selecting one or more databases of claims data and for inputting test data;

extract a first set of claims data from a plurality of submitted claims stored in the one or more databases, wherein the first set of claims data corresponding to a first claim of the plurality of submitted claims;

generate a first EDI 835 transmission by:

formatting the first set of claims data corresponding to the first claim that include a plurality of different data formats into predetermined 835 transmission format standard; and

inserting test data to trigger application of a particular rule that tests an 835 processing system;

generate a merged EDI 835 transmission by merging the first EDI 835 transmission with a second set of claims data corresponding to a second claim of the plurality of submitted claims, wherein the merged EDI 835 transmission is formatted into the 835 transmission format standard;

submit, via network communication, the merged EDI 835 transmission to the 835 processing system for testing performance of the particular rule within the 835 processing system prior to live implementation to test a runtime environment of the 835 processing system; and

based on the electronically testing, electronically determining, via the one or more processors to modify performance and increase a processing power of the 835 processing system.

17. The system of claim 16 , further comprising:

electronically test, via the one or more processors, the particular rule that tests the 835 processing system using the test data of the merged EDI 835 transmission; and

based on the test of the particular rule, determine, via the one or more processors, a particular modification to modify performance of the 835 processing system.

18. The system of claim 16 , further comprising:

extract header information from the first EDI 835 transmission; and

extract header information from another EDI 835 transmission comprising claims data from another claim and the test data.

19. The system of claim 18 , further comprising:

generate the merged EDI 835 transmission by additionally merging the other EDI 835 transmission, the merged EDI 835 transmission having a header merged from the header information from the first EDI 835transmission and the other EDI 835 transmission.

20. The system of claim 16 , wherein the claims data of the merged EDI 835 transmission includes service rendered, provider information, and a code corresponding to the service rendered.

Assignments (1)

Continuity (2)

References Cited (113)