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1. 发明授权

US08666787B2 Method and apparatus for repricing a reimbursement claim against a contract 有权
标题翻译：对合同重新定价报销索赔的方法和设备
公开(公告)号：US08666787B2
公开(公告)日：2014-03-04
申请号：US13709141
申请日：2012-12-10
申请人： TriZetto Corporation
发明人： Mark Lesswing , Dale Hoerle
IPC分类号： G06Q40/00
CPC分类号： G06F19/328 , G06Q10/10 , G06Q40/00 , G06Q40/04 , G06Q40/08 , G06Q50/22
摘要： A method for repricing a reimbursement claim under at least one contract is provided herein. The method may include a combination of steps such as: converting each contract into a series of contractual terms; converting a claim into a series of claim lines, containing claim codes, unit numbers and corresponding charges for the claim codes; comparing claim codes and contractual terms and identifying matches therebetween; determining any priority conditions associated to the matching contractual terms, and eliminate any matching contractual terms that are excluded by the priority conditions; calculating the reimbursement amount for the claim by determining the reimbursement charges for the non-excluded matching contractual terms; and determining and making any adjustments depending upon any discount terms for the entire reimbursement amount.
摘要翻译：本文提供了根据至少一项合同重新定价报销索赔的方法。该方法可以包括步骤的组合，例如：将每个合同转换成一系列合同术语; 将索赔转为一系列索赔行，其中包含索赔代码，单位号码和索赔代码的相应费用; 比较索赔代码和合同条款，并确定其间的匹配; 确定与匹配合同条款相关联的任何优先级条件，并消除优先条件排除的任何匹配合同条款; 通过确定未排除的匹配合同条款的报销费用来计算索赔的报销金额; 并根据整个报销金额的任何折扣条件来确定和进行任何调整。

2. 发明申请

US20140039915A1 System and Method For Selecting Healthcare Management 有权
标题翻译：选择医疗管理的系统和方法
公开(公告)号：US20140039915A1
公开(公告)日：2014-02-06
申请号：US14028710
申请日：2013-09-17
申请人： TriZetto Corporation
发明人： Val C. Dean
IPC分类号： G06Q50/22 , G06Q30/06
CPC分类号： G06F19/328 , G06F19/00 , G06Q30/0631 , G06Q40/08 , G06Q50/22 , G06Q50/24 , G06Q99/00
摘要： The present invention is directed to a system and method which allows a prospective insured to make an informed decision on healthcare insurance or a specific health care management decision by using a current medical profile to assist in their selection. Based on past medical care, as obtained from payor data, a number of different plans, each having different providers, different deductibles, different maximums, different reimbursement policies, etc., a person can make an informed decision. When a family has different payors for different family members, a proper blend of payors can be more easily selected since the payors (or a single payor) has a medical profile of each family member and also has information on providers in the network, prescription policies, deductibles, maximums, etc.
摘要翻译：本发明涉及一种系统和方法，其允许未来被保险人通过使用当前医疗简档来帮助其选择来做出对医疗保险或特定医疗保健管理决策的知情决定。根据过去的医疗保健，从付款人数据中可以看出，一些不同的计划，每个不同的提供者，不同的免赔额，不同的最大值，不同的报销政策等，一个人可以做出明智的决定。当一个家庭对不同的家庭成员有不同的付款人时，由于付款人（或单一付款人）具有每个家庭成员的医疗资料，并且还具有关于网络中的提供者的信息，处方政策可以更容易地选择适当的付款方式，免赔额，最高限额等

3. 发明授权

US10606577B1 System and method for assuring customers during software deployment 有权
公开(公告)号：US10606577B1
公开(公告)日：2020-03-31
申请号：US15345043
申请日：2016-11-07
申请人： TriZetto Corporation
发明人： William L. Benson , Stuart R. Backer , Ryan R. McBurney
IPC分类号： G06F8/61 , H04L29/08
摘要： Deployment assurance services Accelerators (“DAS Accelerators”) include audit functionality that performs a sequential audit of each server listed in a customer's server list from customer's target environment. And artificial intelligence engine (“AI engine”) scans each server to match all required Include entries, which enables categories of product specific checks. Checks for each product category are processed sequentially, including database specific checks. All database platforms can be configured to connect on custom\nonstandard ports, using unique credentials. After each server audit is completed, the audit results are outputted to an encrypted file, a csv or database, depending on how the execution was configured by the customer. Audits review hardware, software, registry, integration and configuration details from customer servers for, e.g., the purpose of validating fitness for use. Various validation and environment reports are generated based on the audit results.

4. 发明申请

US20140039918A1 System and Method For Implementing Program Compliance For Health-Based Rewards 审中-公开
公开(公告)号：US20140039918A1
公开(公告)日：2014-02-06
申请号：US14049874
申请日：2013-10-09
申请人： TriZetto Corporation
发明人： Kathleen Neben , Julie Skeen , Scott Johnson
IPC分类号： G06Q30/00 , G06Q50/22 , G06Q30/02
CPC分类号： G06Q30/018 , G06Q30/02 , G06Q30/0207 , G06Q30/0217 , G06Q40/08 , G06Q50/22
摘要： A compliance process provides the ability to identify members that have completed a required activity for a Health Incentive Program (HIP) by comparing standard data such as claims, pharmacy, laboratory, biometric, health risk assessment and other pertinent internal and external data (hereafter “source data”) against established compliance criteria for that type of data for the specific HIP. If the member meets all compliance criteria within the designated timeframe, the member's achievement is recorded, resulting in the appropriate reward being granted as defined by the HIP. The compliance process solution provides an automated way for a payer to evaluate internal and/or external data including claims, pharmacy and/or biometric data to identify instances of a member completing required activities.

5. 发明申请

US20150294070A1 System and Method For Facilitating the Collection, Analysis, Use and Management of Clinical Analytics Results to Improve Healthcare 有权
标题翻译：促进收集，分析，使用和管理临床分析结果以改善医疗保健的系统和方法
公开(公告)号：US20150294070A1
公开(公告)日：2015-10-15
申请号：US14749133
申请日：2015-06-24
申请人： TriZetto Corporation
发明人： Gerald E. Osband , Rosalind Elaine Therrien , Ivana Naumovic , Scott Johnson
IPC分类号： G06F19/00 , G06Q50/24 , G06F17/30
CPC分类号： G06F19/322 , G06F17/30563 , G06F17/30657 , G06F17/30684 , G06F19/00 , G06F19/345 , G06Q10/063 , G06Q50/22 , G06Q50/24 , G16H10/60 , G16H50/20
摘要： Systems and process for performing analytical processes on the health-related data for a person include components and steps for processing system multiple files from multiple sources containing health-related data for numerous individual. Such processing may include: staging health-related data; matching pieces of staged data to a person using one or more matching rules; compressing the matched staged data for the person into a compressed file through assignment of a universal identifier which is associated with the person; providing the compressed file to an analytics engine; and decompressing the at least one analytics results file using universal identifier to access the analytics results for the person. Additionally, the analytics results for the person may be provided to a user for intervention into the health of the person.
摘要翻译：用于对个人健康相关数据执行分析过程的系统和过程包括用于处理来自多个来源的系统多个文件的组件和步骤，所述多个源包含针对许多个体的健康相关数据。这种处理可以包括：分期健康相关数据; 使用一个或多个匹配规则将分段数据匹配到一个人; 通过分配与该人相关联的通用标识符来将该人的匹配分段数据压缩成压缩文件; 将压缩文件提供给分析引擎; 以及使用通用标识符解压缩所述至少一个分析结果文件以访问所述人的分析结果。此外，该人的分析结果可以被提供给用户以便干预人的健康。

6. 发明申请

US20140297336A1 System and Method For Using a First Electronic Representation of Contract Terms For Generating a Second Electronic Representation of the Contract Terms 审中-公开
标题翻译：使用合同条款的第一个电子表示的系统和方法，用于生成合同条款的第二个电子表示
公开(公告)号：US20140297336A1
公开(公告)日：2014-10-02
申请号：US14304527
申请日：2014-06-13
申请人： TriZetto Corporation
发明人： Dale E. Hoerle , Jeffrey K. Hensley
IPC分类号： G06Q40/08
CPC分类号： G06Q40/08 , G06Q10/10 , G06Q40/00
摘要： Systems and methods are provided in which contract terms from a first electronic representation of a contract are used to form at least a part of a second electronic representation of the contract. For instance, the first electronic representation of a contract may be formed for use with a first software application, such as an adjudication application, and such first electronic representation of the contract is used by a system to form at least part of a second electronic representation of the contract, wherein such second electronic representation is used by a second software application, such as a contract management application. Disparate applications often utilize different representations of contract terms, and certain embodiments enable a second electronic representation to be formed by the system at least in part from a first electronic representation so that the different electronic representations are consistent as to the overlapping contract terms included therein.
摘要翻译：提供了系统和方法，其中使用来自合同的第一电子表示的合同条款形成合同的第二电子表示的至少一部分。例如，合同的第一电子表示可以形成为与第一软件应用（例如裁决申请）一起使用，并且合同的第一电子表示被系统用于形成第二电子表示的至少一部分的合同，其中第二电子表示由诸如合同管理应用的第二软件应用使用。不同的应用程序通常使用合同术语的不同表示，并且某些实施例使得系统能够至少部分地从第一电子表示形成第二电子表示，使得不同的电子表示对于其中包括的重叠合同术语是一致的。

7. 发明申请

US20140249864A1 SYSTEM AND METHOD FOR PROCESSING PAYMENT BUNDLES 审中-公开
标题翻译：处理付款单的系统和方法
公开(公告)号：US20140249864A1
公开(公告)日：2014-09-04
申请号：US14277037
申请日：2014-05-13
申请人： TriZetto Corporation
发明人： Jay Sultan , Howard DOWNS , Dale HOERLE
IPC分类号： G06Q40/08
CPC分类号： G06Q40/08 , G06F19/00 , G06F19/328 , G06Q20/00 , G06Q50/22
摘要： A system and process for prospectively creating patient episodes of care and triggering associated payment bundles during the claim adjudication process facilitates real-time claim pricing in accordance with payment bundle rules to facilitate episodic payment in place of pay-for-service payment. Additionally, various processes are described for modeling patient episodes and payment bundles and unbundling episodic payments.
摘要翻译：在索赔审判过程中，用于前瞻性地创建患者护理事件和触发相关支付捆绑的系统和过程便于根据支付捆绑规则实现实时索赔定价，以便于代付付款付款。此外，描述了各种过程，用于建模患者情节和支付包以及拆分情景支付。

8. 发明申请

US20140207483A1 Health Plan Management Method and Apparatus 有权
标题翻译：健康计划管理方法与设备
公开(公告)号：US20140207483A1
公开(公告)日：2014-07-24
申请号：US14220700
申请日：2014-03-20
申请人： TriZetto Corporation
发明人： Albert R. DiPiero , David G. Sanders
IPC分类号： G06F19/00
CPC分类号： G06F19/34 , G06F19/00 , G06F19/324 , G06F19/328 , G06Q10/10 , G06Q20/04 , G06Q20/28 , G06Q40/00 , G06Q40/02 , G06Q40/06 , G06Q40/08 , G06Q50/22
摘要： Techniques and apparatus for managing contributions to an accruable health spending account in an employer-sponsored plan offering a member an employer-funded defined contribution, at least one insurance premium option and the ability to specify an allocation of the defined contribution for payment of option premiums and in turn, a directed contribution amount designated to such accruable account are disclosed. The accruable account may be used to reimburse the member for qualified medical expenses, and the member may pay any premium shortfall using a tax-advantaged process such as a premium only payment plan. Also disclosed are techniques and apparatus directed to presenting member-specific out-of-pocket expenses for a selected procedure offered by at least one health-care provider.
摘要翻译：在雇主资助的计划中管理对可追加的健康支出帐户的捐款的技术和设备，为成员提供雇主资助的定义的供款，至少一种保险费选项，以及指定分配定额供款以支付期权保费的能力反过来，披露了指定给这样的应收账款的定向缴款金额。应收账款可用于偿还会员资格的医疗费用，会员可以使用税收优惠流程（如仅保费付款计划）支付任何溢价短缺。还公开了旨在呈现由至少一个保健提供者提供的所选程序的成员特定的自付费用的技术和装置。

9. 发明授权

US10942987B1 Healthcare claim data recreation for support and analysis 有权
公开(公告)号：US10942987B1
公开(公告)日：2021-03-09
申请号：US15386698
申请日：2016-12-21
申请人： TriZetto Corporation
发明人： Sibi Mathivanan , Aarti Vaswani
IPC分类号： G06F19/00 , G06F16/28 , G06F16/22
摘要： Enhanced methods for providing software support and resolving software support issues are provided, particularly those related to an entity, including a specific entity in a database. A method selects an entity, such as a healthcare claim or other entity in a database, for which there is a software issue. The method then identifies all data and relationships relevant to that entity, including all related tables and data for that entity. The specific entity, data, and relationships are then exported. This method provides better, more efficient, and enhanced software support by exporting not only the identified entity, but all other relevant data and relationships to that entity, for analysis in resolving any software support issues.

10. 发明授权

US09152386B1 Method and system for rapid upgrade through transactional analysis 有权
标题翻译：通过事务性分析快速升级的方法和系统
公开(公告)号：US09152386B1
公开(公告)日：2015-10-06
申请号：US13793090
申请日：2013-03-11
申请人： TriZetto Corporation
发明人： Dustin Rojas
IPC分类号： G06F9/44 , G06F9/445
CPC分类号： G06F8/20 , G06F8/65 , G06F11/3668
摘要： A process for identifying functional and detailed design decisions in a core software architecture across multiple applications and clients includes comparing the results of two independent review sub processes to rapidly build an upgrade testing matrix. The two sub process include an independent functional review and a regression analysis using data extracts from historical data generated from client use of the core software architecture.
摘要翻译：在跨多个应用程序和客户端的核心软件架构中识别功能和详细设计决策的过程包括比较两个独立审核子流程的结果，以快速构建升级测试矩阵。两个子过程包括使用从客户端使用核心软件架构生成的历史数据中提取的数据的独立功能审查和回归分析。

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