US 11,810,197 B2
Systems and methods for benefit plan quality assurance and certification
Dheeraj Misra, Somerset, NJ (US); Sandipan Gangopadhyay, Somerset, NJ (US); and Tim Bryan, Somerset, NJ (US)
Assigned to GalaxE.Solutions, Inc., Somerset, NJ (US)
Filed by GalaxE.Solutions, Inc., Somerset, NJ (US)
Filed on Jan. 17, 2020, as Appl. No. 16/746,247.
Claims priority of provisional application 62/794,367, filed on Jan. 18, 2019.
Prior Publication US 2020/0234381 A1, Jul. 23, 2020
Int. Cl. G06Q 40/08 (2012.01); G06F 3/04847 (2022.01); G16H 10/60 (2018.01); G06Q 10/1057 (2023.01)
CPC G06Q 40/08 (2013.01) [G06F 3/04847 (2013.01); G06Q 10/1057 (2013.01); G16H 10/60 (2018.01)] 18 Claims
OG exemplary drawing
 
1. A system for building and testing a target benefit plan file, the system comprising:
an intake engine configured to intake source files reflecting a source benefit plan and to apply automated parsing and cross-application dependency mapping to identify a plurality of benefit plan components and associated cross-dependencies from the source files, wherein the automated parsing and cross-application dependency mapping includes:
placing file paths of the source files into a parsing queue,
starting a plurality of configured threads,
selecting, by each configured thread, a respective source file corresponding to a file path stored in the parsing queue,
looping, by each respective configured thread, through each respective line in the associated selected source file associated with the respective configured thread, in order to obtain parsed information characterizing execution dependencies for function, transaction and service calls of each of the benefit plan components with and across administrative workflows and systems;
a build engine configured to autonomously generate model benefit plan components from duplicative benefit plan components in the plurality of benefit plan components, and to assemble the target benefit plan file from the model benefit plan components, wherein the target benefit plan file is a compiled computer data object that maps the identified cross-dependencies of the benefit plan components based on the parsed information;
a test adjudication engine operating within a virtual staging environment, configured to execute a test adjudication that test processes claims in accordance with the target benefit plan file being tested so as to determine whether the target benefit plan file is built in accordance with a captured user intent, each of the claims having one or more parameters;
a database, configured to store the benefit plan file and quality assurance data, the quality assurance data including: (a) historical claims, each historical claim having an associated historical adjudication, and (b) new claims, each new claim not having an associated historical adjudication; and
a graphical user interface, including an interactive dashboard configured to:
allow a user to interact with the virtual staging environment so as to define a scope of the test adjudication by selectively batching claims for the test adjudication processing by the test adjudication engine, from among the historical claims and the new claims, based on the one or more parameters; and
allow the user to visually navigate, via one or more hyperlinks, between and within architectural tiers of the target benefit plan file being tested, so as to trace the test adjudication between the architectural tiers of the target benefit plan file being tested.