Abstract: 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.

Abstract: 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.

Abstract: 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.