Patents Assigned to Emergis Inc.
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Patent number: 8930230Abstract: A system and method for implementing an insurance plan to coordinate an adjudication of a submitted claim corresponding to the plan. The plan includes a people model and a benefit model, such as hierarchical trees combined by a plurality of policies. The system and method comprise assigning a first predefined inheritance of global attributes to coupled elements of the people tree and assigning a second predefined inheritance of global attributes to coupled elements of the benefits tree. The system and method also assigning a local administration rule for at least one local attribute of the trees, the assignment between a selected people element of the people tree and a selected benefit element of the benefits tree. The local administration rule overrides the corresponding global attributes of the selected elements, such that resolution of the global attributes with the local attributes for the selected elements provides a rule set for adjudication of the submitted claim.Type: GrantFiled: December 11, 2012Date of Patent: January 6, 2015Assignee: Emergis Inc.Inventors: Mike Schmidt, Darren Wilson-Rymer, Scott Sievert, Jane Goguen, Ron Reynolds
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Publication number: 20140249975Abstract: A system for coordinating the submission and processing of a bill according to predictive payment data of a plan. The system comprises a provider interface and an integrated database for receiving a predictive payment plan submitted from the provider interface. The system also has a predictive payment request of the plan storable in the database, the request including a plurality of predictive payment parameters. An adjudication engine is coupled to the integrated database, and an insertion function is used for inserting the predictive payment parameters, when stored in the database, into an adjudication rule set of the adjudication engine. The adjudication rule set is used for eventual adjudication of the predictive payment data, wherein adjudication of the predictive payment data results in the generation of the bill.Type: ApplicationFiled: October 9, 2013Publication date: September 4, 2014Applicant: Emergis Inc.Inventors: Mike Schmidt, Ilan Grosman, David Johnston, Bob Ransom
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Patent number: 8825504Abstract: A system and method for modifying benefit coverage including a plurality of benefit codes of an insurance plan, the insurance plan for use in adjudicating one or more insurance claims. The system and method including accessing a set of benefit codes structured in a plurality of benefit containers including a primary benefit container and a plurality of secondary benefit containers, each of the plurality of secondary benefit containers being coupled to the primary benefit container by a respective benefit container reference, each of the plurality of secondary benefit containers containing one or more benefit codes adapted for processing a claim content of the one or more insurance claims, each of the one or more benefit codes being coupled to their respective secondary benefit container by a respective benefit reference, the set of benefit codes defining a benefit hierarchy.Type: GrantFiled: February 18, 2009Date of Patent: September 2, 2014Assignee: Emergis, Inc.Inventors: Rob Tholl, Raymond Leung, Clayton Russell
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Patent number: 8706532Abstract: A system and method for processing insurance claims using a set of adjudication rules. The method and system comprises receiving a claim for processing, such that the received claim having claim content including a claim date. Also provided is a database configured for accessing the set of adjudication rules appropriate to the received claim, the set of adjudication rules structured in containers including a primary rule container and secondary rule containers, each of the secondary rule containers being coupled to the primary rule container by a respective container reference, each of the secondary rule containers containing one or more adjudication rules adapted for processing the claim content of the received claim, each of the one or more adjudication rules being coupled to their respective secondary container by a respective rule reference, the set of adjudication rules defining a rule hierarchy.Type: GrantFiled: November 26, 2012Date of Patent: April 22, 2014Assignee: Emergis Inc.Inventors: Rob Tholl, Raymond Leung, Clayton Russell
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Patent number: 8645168Abstract: A system for coordinating the submission and processing of a bill according to predictive payment data of a plan. The system comprises a provider interface and an integrated database for receiving a predictive payment plan submitted from the provider interface. The system also has a predictive payment request of the plan storable in the database, the request including a plurality of predictive payment parameters. An adjudication engine is coupled to the integrated database, and an insertion function is used for inserting the predictive payment parameters into an adjudication rule set of the adjudication engine. The adjudication rule set is used for eventual adjudication of the predictive payment data, wherein adjudication of the predictive payment data results in the generation of the bill. The system also has a workflow engine for coordinating the processing of the electronic bill and for updating the bill information in response to processing.Type: GrantFiled: May 2, 2007Date of Patent: February 4, 2014Assignee: Emergis Inc.Inventors: Mike Schmidt, Ilan Grosman, David Johnston
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Publication number: 20130166327Abstract: A system and method for implementing an insurance plan to coordinate an adjudication of a submitted claim corresponding to the plan. The plan includes a people model and a benefit model, such as hierarchical trees combined by a plurality of policies. The system and method comprise assigning a first predefined inheritance of global attributes to coupled elements of the people tree and assigning a second predefined inheritance of global attributes to coupled elements of the benefits tree. The system and method also assigning a local administration rule for at least one local attribute of the trees, the assignment between a selected people element of the people tree and a selected benefit element of the benefits tree. The local administration rule overrides the corresponding global attributes of the selected elements, such that resolution of the global attributes with the local attributes for the selected elements provides a rule set for adjudication of the submitted claim.Type: ApplicationFiled: December 11, 2012Publication date: June 27, 2013Applicant: EMERGIS INC.Inventor: Emergis Inc.
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Publication number: 20130151287Abstract: A system and method for processing insurance claims using a set of adjudication rules. The method and system comprises receiving a claim for processing, such that the received claim having claim content including a claim date. Also provided is a database configured for accessing the set of adjudication rules appropriate to the received claim, the set of adjudication rules structured in containers including a primary rule container and secondary rule containers, each of the secondary rule containers being coupled to the primary rule container by a respective container reference, each of the secondary rule containers containing one or more adjudication rules adapted for processing the claim content of the received claim, each of the one or more adjudication rules being coupled to their respective secondary container by a respective rule reference, the set of adjudication rules defining a rule hierarchy.Type: ApplicationFiled: November 26, 2012Publication date: June 13, 2013Applicant: EMERGIS INC.Inventor: Emergis Inc.
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Publication number: 20130067321Abstract: A multi-tier application for interaction with a user interface, such as a browser on a PC or PDA. The application comprises a presentation tier (such as a web server with a JSP/servlet engine) and a business logic tier (such as an application server) to manipulate data for subsequent presentation on the user interface. A direction module has a plurality of coupled directions, including a function direction to direct a corresponding functional component to perform a data processing function using the business logic tier and provide a data processing output, and a presentation direction to direct a corresponding presentation component to incorporate the data processing output, when applicable, into a presentation template to produce a presentation element for the user interface. The function component and presentation component are independent and separate from each other, the connection being the function component produces the data and the presentation component consumes the output data.Type: ApplicationFiled: October 23, 2012Publication date: March 14, 2013Applicant: EMERGIS INC.Inventor: EMERGIS INC.
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Patent number: 8374893Abstract: A system and method for implementing an insurance plan to coordinate an adjudication of a submitted claim corresponding to the plan. The plan includes a people model and a benefit model, such as hierarchical trees combined by a plurality of policies. The system and method comprise assigning a first predefined inheritance of global attributes to coupled elements of the people tree and assigning a second predefined inheritance of global attributes to coupled elements of the benefits tree. The system and method also assigning a local administration rule for at least one local attribute of the trees, the assignment between a selected people element of the people tree and a selected benefit element of the benefits tree. The local administration rule overrides the corresponding global attributes of the selected elements, such that resolution of the global attributes with the local attributes for the selected elements provides a rule set for adjudication of the submitted claim.Type: GrantFiled: August 30, 2007Date of Patent: February 12, 2013Assignee: Emergis IncInventors: Mike Schmidt, Darren Willson-Rymer, Jane Goguen, Ron Reynolds
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Patent number: 8355930Abstract: A system and method for processing insurance claims using a set of adjudication rules. The method and system comprises receiving a claim for processing, such that the received claim having claim content including a claim date. Also provided is a database configured for accessing the set of adjudication rules appropriate to the received claim, the set of adjudication rules structured in containers including a primary rule container and secondary rule containers, each of the secondary rule containers being coupled to the primary rule container by a respective container reference, each of the secondary rule containers containing one or more adjudication rules adapted for processing the claim content of the received claim, each of the one or more adjudication rules being coupled to their respective secondary container by a respective rule reference, the set of adjudication rules defining a rule hierarchy.Type: GrantFiled: February 18, 2009Date of Patent: January 15, 2013Assignee: Emergis Inc.Inventors: Rob Tholl, Raymond Leung, Clayton Russell
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Patent number: 8321879Abstract: A multi-tier application for interaction with a user interface. The application comprises a presentation tier (e.g. a web server with a JSP/servlet engine) and a business logic tier (e.g. an application server) to manipulate data for subsequent presentation on the user interface. A direction module, such as a requested resource definition, has a plurality presentation and function definitions for accessing a presentation component defined externally to the requested resource definition and the function definition for identifying a function component also defined externally to the requested resource definition.Type: GrantFiled: May 27, 2008Date of Patent: November 27, 2012Assignee: Emergis Inc.Inventors: Lenny Hon, Ken Schneider
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Patent number: 8108274Abstract: A system for coordinating the submission and processing of a bill according to predictive payment data of a plan. The system comprises a provider interface and an integrated database for receiving a predictive payment plan submitted from the provider interface. The system also has a predictive payment request of the plan storable in the database, the request including a plurality of predictive payment parameters. An adjudication engine is coupled to the integrated database, and an insertion function is used for inserting the predictive payment parameters, when stored in the database, into an adjudication rule set of the adjudication engine. The adjudication rule set is used for eventual adjudication of the predictive payment data, wherein adjudication of the predictive payment data results in the generation of the bill.Type: GrantFiled: October 22, 2002Date of Patent: January 31, 2012Assignee: Emergis Inc.Inventors: David Johnston, Mike Schmidt, Ilan Grosman, Bob Ransom
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Publication number: 20100211413Abstract: A system and method for revising one or more hierarchies of an insurance plan, the insurance plan for use in adjudicating one or more insurance claims. The method and system comprising obtaining one or more claims from a claims queue, the claims queue for storing claims selected for review. The system and method comprising accessing at least one of a set of benefit codes or a set of adjudication rules associated with the insurance plan of the obtained one or more claims, wherein at least some of the set of benefit codes or the set of adjudication rules are structured in a plurality of containers.Type: ApplicationFiled: February 18, 2009Publication date: August 19, 2010Applicant: Emergis Inc.Inventors: Rob Tholl, Raymonf Leung, Clayton Russell
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Publication number: 20100211412Abstract: A system and method for processing insurance claims using a set of adjudication rules. The method and system comprises receiving a claim for processing, such that the received claim having claim content including a claim date. Also provided is a database configured for accessing the set of adjudication rules appropriate to the received claim, the set of adjudication rules structured in containers including a primary rule container and secondary rule containers, each of the secondary rule containers being coupled to the primary rule container by a respective container reference, each of the secondary rule containers containing one or more adjudication rules adapted for processing the claim content of the received claim, each of the one or more adjudication rules being coupled to their respective secondary container by a respective rule reference, the set of adjudication rules defining a rule hierarchy.Type: ApplicationFiled: February 18, 2009Publication date: August 19, 2010Applicant: Emergis Inc.Inventors: Rob Tholl, Raymond Leung, Clayton Russell
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Publication number: 20100211414Abstract: A system and method for configuring a set of adjudication rules for use in processing an insurance claim. The method and system comprise defining an adjudication rule and defining a secondary rule container and coupling the adjudication rule to the secondary rule container by a rule reference associated with the content of the secondary rule container. Also implemented is defining a primary rule container and coupling the secondary rule container to the primary rule container by a container reference associated with the content of the primary rule container, the adjudication rule, the containers, and the rule and container reference defining a rule hierarchy for representing the set of adjudication rules.Type: ApplicationFiled: February 18, 2009Publication date: August 19, 2010Applicant: Emergis Inc.Inventors: Rob Tholl, Raymond Leung, Clayton Russell
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Publication number: 20100211415Abstract: A system and method for modifying benefit coverage including a plurality of benefit codes of an insurance plan, the insurance plan for use in adjudicating one or more insurance claims. The system and method including accessing a set of benefit codes structured in a plurality of benefit containers including a primary benefit container and a plurality of secondary benefit containers, each of the plurality of secondary benefit containers being coupled to the primary benefit container by a respective benefit container reference, each of the plurality of secondary benefit containers containing one or more benefit codes adapted for processing a claim content of the one or more insurance claims, each of the one or more benefit codes being coupled to their respective secondary benefit container by a respective benefit reference, the set of benefit codes defining a benefit hierarchy.Type: ApplicationFiled: February 18, 2009Publication date: August 19, 2010Applicant: Emergis Inc.Inventors: Rob Tholl, Raymond Leung, Clayton Russell
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Patent number: 7734999Abstract: A system and method for configuring a user formset for display on a user interface of a client computer, the client computer coupled by a network to a formset server, the user formset for providing interaction with a network transaction, the user formset described in a structured definition language.Type: GrantFiled: January 3, 2005Date of Patent: June 8, 2010Assignee: Emergis Inc.Inventors: Raymond Leung, Clayton Russell, Jim Josephs, Rob Tholl
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Patent number: 7389517Abstract: A multi-tier application for interaction with a user interface comprises a presentation tier (e.g. a web server with a JSP/servlet engine) and a business logic tier (e.g. an application server) to manipulate data for subsequent presentation on the user interface. A direction module, such as a requested resource definition, has a plurality presentation and function definitions for accessing a presentation component defined externally to the requested resource definition and the function definition for identifying a function component also defined externally to the requested resource definition.Type: GrantFiled: December 19, 2003Date of Patent: June 17, 2008Assignee: RCE Emergis, Inc.Inventors: Lenny Hon, Ken Schneider
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Patent number: 7054844Abstract: A secure electronic procurement system allows a user (e.g. pharmacist) to order and confirm receipt electronically over a network (e.g. Internet) goods normally subject to a verifiable chain of custody (e.g. narcotics, controlled drugs and substances, other public distribution regulated goods or valuables). The system includes hardware and software for a user device, a secure procurement system, a supplier system and a certificate authority to authenticate communications, particularly user orders and confirmed receipts. The supplier system may be a legacy EDI based order system. Copies of electronic orders, shipping notices and receipts confirming shipment received together with digital signatures are securely stored for audit trail purposes. Business rules within the secure procurement system operate to ensure proper adherence to the chain of custody.Type: GrantFiled: January 5, 2001Date of Patent: May 30, 2006Assignee: BCE Emergis Inc.Inventors: Robert J. Fletcher, Neil C. McPhedran