Method and computer program product for processing insurance claims according to a plurality of rules

Abstract

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.