US 12,073,470 B2
Machine structured plan description
Asif Khalak, Belmont, CA (US); Sergio Martinez-Ortuno, Oakland, CA (US); Henning Chiv, Castro Valley, CA (US); Michelle Alicia Gard, San Mateo, CA (US); and Emma Louise Wise, San Francisco, CA (US)
Assigned to CollectiveHealth, Inc., San Francisco, CA (US)
Filed by CollectiveHealth, Inc., San Mateo, CA (US)
Filed on Jul. 18, 2022, as Appl. No. 17/867,365.
Application 17/867,365 is a continuation of application No. 16/730,808, filed on Dec. 30, 2019, granted, now 11,393,039.
Application 16/730,808 is a continuation of application No. 16/107,262, filed on Aug. 21, 2018, granted, now 10,552,915, issued on Feb. 4, 2020.
Prior Publication US 2023/0044782 A1, Feb. 9, 2023
Int. Cl. G06Q 40/08 (2012.01); G06Q 10/1057 (2023.01)
CPC G06Q 40/08 (2013.01) [G06Q 10/1057 (2013.01)] 20 Claims
OG exemplary drawing
 
1. A computer-implemented method comprising:
receiving, by a plan authoring tool executing via one or more computing devices, user input describing one or more parameters of one or more benefits of a draft benefit plan;
translating, by the plan authoring tool, the user input into a draft machine structured plan description (MSPD) that defines the draft benefit plan and represents the one or more benefits as plan objects of the draft MSPD;
generating, by one or more plan analysis tools executing via the one or more computing devices, feedback associated with the draft benefit plan based on at least one of:
validating that the draft benefit plan, defined by the draft MSPD, satisfies one or more validation conditions, or
simulating automatic adjudication of sample claims, based on the draft MSPD, via an automatic claim adjudication system executing via the one or more computing devices;
approving, based on the feedback:
the draft benefit plan as a final benefit plan, and
the draft MSPD as a final MSPD that defines the final benefit plan; and
providing the final MSPD to at least one of:
a plan documentation generator, executing via the one or more computing devices, configured to automatically generate one or more plan documents based on the final MSPD, or
the automatic claim adjudication system, wherein the automatic claim adjudication system is configured to use the final MSPD to automatically adjudicate claims submitted in association with the final benefit plan.