Rules engine framework

Abstract

An apparatus is provided. The apparatus comprises a computer system and an integrated development environment application. When executed on the computer system, the integrated development environment application promotes defining a plurality of rules based on a plurality of generic templates and automatically incorporating input value validation based on a type of a left hand variable into the rules. The rules, when executed by a healthcare management information system rules engine, promote enrollment of health care providers and healthcare system members and processing of healthcare claims.

1 . An apparatus, comprising:
 a computer system; and   an integrated development environment application that, when executed on the computer system, promotes defining a plurality of rules based on a plurality of generic templates and automatically incorporating input value validation based on a type of a left hand variable into the rules,   wherein the rules, when executed by a healthcare management information system rules engine, promote enrollment of health care providers and healthcare system members and processing of healthcare claims.   
     
     
         2 . The apparatus of  claim 1 , wherein the generic templates comprise custom templates comprising at least one of a generic template, system lists custom template, a system parameters custom template, and a valid values custom template. 
     
     
         3 . The apparatus of  claim 1 , wherein the generic templates comprise an IN LIST generic template and a NOT IN LIST generic template. 
     
     
         4 . The apparatus of  claim 1 , wherein integrated development environment provides a plurality of custom providers. 
     
     
         5 . The apparatus of  claim 4 , wherein the custom providers comprise at least one of a database custom provider and an array object custom provider. 
     
     
         6 . The apparatus of  claim 1 , wherein the rules are defined at least in part as the left hand variable associated with a right hand input based on the generic templates. 
     
     
         7 . A method of processing a healthcare claim, comprising:
 composing a rule from at least one of a generic template, system parameters custom template, a system list custom template, and a valid values custom template;   invoking a business process function to process a healthcare claim;   wherein the business process invokes the rule to be processed by a rules engine;   wherein the rules engine returns the result of processing the rule in a rule return object; and   wherein the business process approves payment or suspends the healthcare claim based on the rule return object.   
     
     
         8 . The method of  claim 7 , further comprising compiling the rule into an advanced database binary format, wherein the rules engine processes the rule in the advanced database binary format. 
     
     
         9 . The method of  claim 7 , wherein the business process and the rules engine are part of a healthcare management information system. 
     
     
         10 . The method of  claim 9 , wherein the healthcare management information system is a Medicaid management information system. 
     
     
         11 . The method of  claim 7 , wherein the rule comprises at least one of an IN SET operator, and a NOT IN SET operator. 
     
     
         12 . The method of  claim 7 , wherein the rule comprises at least one of a NOT IN operator, IS IN operation, greater than operator, less than operator, equal to operator, less than or equal to operator, greater than or equal to operator. 
     
     
         13 . The method of  claim 7 , wherein the rule comprises at least one of an ADD operator, a SUBTRACT operator, a MULTIPLY operator, and a DIVIDE operator. 
     
     
         14 . A system, comprising:
 a computer system; and   a rules engine framework that, when executed on the computer system,
 promotes composing a plurality of rules, wherein each rule is composed at least in part from a left hand variable associated with a right hand input by an operator, and automatically incorporating input value validation of the right hand input based on the type of the left hand variable, wherein the at least some of the rules are composed based on at least one of a generic template, system list custom template, a system parameters custom template, and a valid values custom template, and 
 builds a healthcare management information system rules engine based at least in part on a plurality of custom providers, 
 wherein the healthcare management information system rules engine promotes enrollment of health care providers and patients and promotes healthcare claims processing. 
   
     
     
         15 . The system of  claim 14 , wherein the custom providers comprise a database custom provider and an array object custom provider. 
     
     
         16 . The system of  claim 15 , wherein the database custom provider extends the off-the-shelf functionality of healthcare management information system rules engine by enabling reading two or more columns of data from a database during one read transaction. 
     
     
         17 . The system of  claim 15 , wherein the database custom provider extends the off-the-shelf functionality of the healthcare management information system rules engine by enabling access to the elements of an array object. 
     
     
         18 . The system of  claim 14 , wherein the healthcare management information system rules engine promotes enrollment of health care providers and patients in a state operated Medicaid program and promotes Medicaid claims processing. 
     
     
         19 . The system of  claim 14 , wherein the value checking comprises verifying that age values are in the range from 0 to 130. 
     
     
         20 . The system of  claim 19 , wherein the rules engine framework further promotes composing a rule based on at least one of an IN LIST operator and a NOT IN LIST operator.