Data processing: database and file management or data structures – Database design – Data structure types
Reexamination Certificate
1999-12-30
2002-11-19
Von Buhr, Maria N. (Department: 2125)
Data processing: database and file management or data structures
Database design
Data structure types
C707S793000, C707S793000
Reexamination Certificate
active
06484178
ABSTRACT:
TECHNICAL FIELD
The present invention relates to a method, computer program product and computer system for adapting file formats. In particular, it is directed to the acceptance of files formatted in one file format and converting the files into a common file format. This has particular application in the electronic processing of insurance claims.
BACKGROUND OF THE INVENTION
In such industries as the electronic insurance claims processing industry, numerous different claim file formats are used, depending upon the source of the files. In the insurance industry, for example, such formats include HCFA-1500 print images, a standardized format developed by the U.S. Healthcare Financing Administration, UB92 print images and others. Additionally, even within a given format, different generators of files may use the formats differently.
This proliferation of different file formats and variations on file formats has led to difficulties in the electronic processing of such files. In the past, a company that performed such processing would have to receive a test file from each new client, and a (human) programmer would have to develop software specific to the particular client's file format. Each of such pieces of software was called a “scrubber program,” and each scrubber program would generally need to be developed anew for each client (on occasion, a common scrubber program could be used for more than one client). This process was very expensive, requiring large amounts of manpower, and was, thus, also slow.
While some format translation programs do exist, such programs have tended to be very slow, capable of processing approximately one claim per minute. In a high volume business, such translation rates are unacceptable, requiring too much time to process the claims.
SUMMARY OF THE INVENTION
It is an object of the present invention to provide a claim formatting method and computer program product capable of accepting files in numerous formats, which may be initially unknown, and formatting them into a common format for processing.
It is a further object of the present invention to do so with a reduced amount of human labor, in comparison with prior-art methods.
It is a further object of the present invention to do so in such a way that the method/computer program can learn input formats that it has not processed before.
It is yet a further object of the present invention to do such formatting at a high rate of speed.
These and other objects are achieved by the inventive method and system.
The method of the present invention comprises steps of: (1) viewing information about the client or office submitting a file containing data records (e.g., claims); (2) examining the submitted client data file; (3) finding a known data format that most closely matches the format of the client data file, known data formats being stored in a format database; (4) aligning the data contained in a given record, thus, creating a format corresponding to the client's data format; and (5) if the resulting format is different from all formats in the format database, saving the newly-created client format as a new known format. As a step between steps (4) and (5), the method may also allow the testing of the newly-created format on the client's data file by a “running claim edits” function; this function serves to mass convert the client's data records into a common data format and permits testing of the conversion. The method may further comprise a step of writing a scrubber program, should the above steps fail.
The step of examining the submitted client data file includes an optional step of “collecting garbage.” This step involves such functions as removing extraneous control characters and correcting for non-standard formatting conventions. For example, standard control characters may be added to each record to standardize the format.
The system of the present invention comprises a computer having software embodied on a computer-readable medium, the software implementing the above method and comprising: (1) a View Office Information module, providing an operator with the ability to view information about a client/office submitting a file containing data records (e.g., claims); (2) an Examine Test Claim File module, allowing the operator to view data from the file submitted by the client; (3) a Find Closest Match module, automatically searching a known format database for a format that most closely matches the format of the data records in the client data file; (4) an Align Claim Data module, providing the operator with the capability of modifying the closest matching data format to create a new format matching the specific client's data record format; and (5) a Save Office Format module, allowing the operator to save the newly-created data format in the known format database. The software may further include a Run Claim Edits module that allows the operator to test the newly-created format on the client's data file; Run Claim Edits performs format conversion into a common data format using the newly-created format and permits the observer to ascertain whether or not the conversion was successful. The software may further comprise at least one scrubber program written separately to account for file formats for which the program modules above fail to produce acceptable results.
The Examine Test Claim File module includes an optional Garbage Collection module. This module involves such functions as removing extraneous control characters and correcting for non-standard formatting conventions. For example, standard control characters may be added to each record to standardize the format.
Definitions
A “computer” refers to any apparatus that is capable of accepting a structured input, processing the structured input according to prescribed rules, and producing results of the processing as output. Examples of a computer include: a computer; a general purpose computer; a supercomputer; a mainframe; a super mini-computer; a mini-computer; a workstation; a micro-computer; a server; an interactive television; and a hybrid combination of a computer and an interactive television. A computer also refers to two or more computers connected together via a network for transmitting or receiving information between the computers. An example of such a computer includes a distributed computer system for processing information via computers linked by a network.
A “computer-readable medium” refers to any storage device used for storing data accessible by a computer. Examples of a computer-readable medium include: a magnetic hard disk; a floppy disk; an optical disk, like a CD-ROM or a DVD; a magnetic tape; a memory chip; and a carrier wave used to carry computer-readable electronic data, like those used in transmitting and receiving e-mail or in accessing a network.
“Software” refers to prescribed rules to operate a computer. Examples of software include: software; code segments; instructions; computer programs; program modules; and programmed logic.
A “computer system” refers to a system having a computer, where the computer includes a computer-readable medium embodying software to operate the computer.
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Bence, Jr. Gene Philip
Julian Gary
Kenney William Raymond
Peet John L.
Reinholdt Daniel Robert
Gluck Jeffrey W.
The Merallis Company
Venable
Von Buhr Maria N.
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