Abstract: An electronic pharmacy adjudication system and associated method and computer program product for performing adjudication service for a healthcare insurance claim is provided. The system includes an interface layer, an orchestration layer and a service and rules engine layer configured for receiving, processing and releasing an adjudication decision. The orchestration layer processes the healthcare insurance claim to generate a sequence of service calls to the service and rules engine layer to derive a sequence of partial decision results, which are derived by processing a set of parameters identified by the service call according to a corresponding subset of decisions rules in a rules repository. The sequence of partial decision results is then processed to derive the adjudication decision corresponding to the healthcare insurance claim.

Abstract: The present disclosure relates generally to utilizing paid time off. In one example, the systems and methods described herein may provide an infrastructure to repurpose paid time off into other uses, such as cash, travel, bill payments, and the like.

Abstract: The present disclosure relates generally to utilizing paid time off. In one example, the systems and methods described herein may provide an infrastructure to repurpose paid time off into other uses, such as cash, travel, bill payments, and the like.

Abstract: In some embodiments of the present disclosure, techniques are utilized that allow answers to be provided to end users such as health care consumers, based on benefit book documents. The benefit book documents, which do not initially contain machine-readable structural or semantic information, are processed in order to detect structure and create semantic content based on the structure. This semantic content may then be added to a graph that represents the information contained in the benefit book document. A computing device may then use the nodes of this graph to answer questions received from consumers, where templates that provide answers to the questions reference the nodes of the graph.

Abstract: Methods and apparatus for updating a denormalized database object after updating, deleting, or inserting a record in a source database object are described. A first operation on a source database object that involves a record of the source database object being updated, deleted, or inserted is performed. A first part of a corresponding second operation involving a respective record of the denormalized database object being updated, deleted, or inserted is performed. A query result that references an aggregate field of a set of records in the denormalized database object is altered. The altering includes an aggregation operation using values in the query result being performed and altering that part of the query result that includes the aggregate field of the set of records. A second part is optionally performed to complete the corresponding second operation and update the denormalized database object.

Abstract: A computer-implemented method, system and computer program product are used to provide a factor in a first domain for a first set of data and in a second domain for a second set of data. The computer-implemented method, system and computer program product then determine a relationship between the domains in term of the factor. The computer-implemented method, system and computer program product determine for the first domain whether the factor from the second domain has changed, and if so, create domain specific records for the first domain in response to determining that the factor from the second domain has changed.

Abstract: A method for managing vendor services provided at an employer service location includes provisioning an item or service offered by a vendor at the employer service location and receiving an order for the provisioned item or service from an employee and communicating the received order to the vendor, the vendor capable of providing the item or service at the employer service location, wherein the employer location is associated with the employee and the item or service. The method also includes scheduling a time for the vendor to provide the item or service at an employer service location based at least in part on an availability of an employee, availability of the vendor, or availability of the employer service location. The method also includes processing a payment from at least one of the employee or employer for the ordered item or service and distributing the payment to the vendor.

Abstract: In some embodiments of the present disclosure, techniques are utilized that allow answers to be provided to end users such as health care consumers, based on benefit book documents. The benefit book documents, which do not initially contain machine-readable structural or semantic information, are processed in order to detect structure and create semantic content based on the structure. This semantic content may then be added to a graph that represents the information contained in the benefit book document. A computing device may then use the nodes of this graph to answer questions received from consumers, where templates that provide answers to the questions reference the nodes of the graph.

Abstract: Systems and methods for handling a telecommunications session in real-time are provided, where the telecommunications session is initiated by a calling device and intended for a receiving network. One system comprises a module, in communication with a communications network associated with the telecommunications session, configured for intercepting the telecommunications session prior to reaching the receiving network, obtaining address information associated with the calling device, determining a credit-related score for the telecommunications session based on the address information, identifying an appropriate unit of the receiving network based on the credit-related score, and routing the telecommunications session to the appropriate unit. The system also includes a memory for storing the module and a processor in communication with the memory to execute the module.

Abstract: An information processing apparatus includes an extraction unit that extracts, if a third axis is inserted between a first axis and a second axis adjacent to each other in a deployment table, a relations diagram associated with the deployment table and an insertion unit that inserts, in the relations diagram, a third item relating to an axis item of a the third axis between a first item relating to an axis item of the first axis and a second item relating to an axis item of the second axis.

Abstract: Managing data in a multitenant environment having a relational database and a non-relational database. A set of one or more policies for data retention corresponding to data stored in the relational database environment is received. The policies for data retention are defined on a tenant-by-tenant basis within the multitenant environment. The policies are deployed to data in the relational database on a tenant-by-tenant basis within the multitenant environment. Data to be copied from the relational database to the non-relational database is identified. The data to be copied in the non-relational database is stored while maintaining tenant isolation so that data belonging to the respective tenants is not accessible by other tenants when stored in the non-relational database.

Abstract: Establishing hierarchical user management authority for storage resources organized into resource groups in a computing storage environment are provided. Each storage resource is associated with a resource group and storage resource object having a resource group attribute associating the storage resource object with one of the resource groups. The resource group label attribute is assigned to the resource group object. An additional attribute of the resource group object, that specifies management policies for the resource group object and the storage resources associated with the resource group object, is defined. One of the available users of the storage resources is associated with a user resource scope attribute. A schema is defined for comparing of values of the user resource scope attribute with the resource group label attribute.

Abstract: A method includes forming a working mixed integer linear program (MILP) from a given MILP at least by choosing a subset of variables from the MILP, wherein the working MILP includes the chosen subset of variables but no other variables from the given MILP. The working MILP is solved to determine a solution. Using the solution, a special linear program is formed and solved to determine a price of each constraint relative to the solution. Using the prices, variables that are not in the working MILP are evaluated to determine any variables that can contribute to an improved solution. The variables evaluated as contributing to an improved solution are added to the working MILP. The working MILP with the added variables is solved. Apparatus and program products are also disclosed.

Abstract: Systems and methods for processing documents involve directing an imager at a document and automatically capturing the document when predetermined criteria are satisfied. The captured document can then be subjected to image processing, including separating the document into individual data field images and performing optical character recognition (OCR) processing on the individual data fields so extract data that can then be used to determine eligibility for benefits.

Abstract: A system for determining, for selected insurance groups, a behavior modification program for modifying a first select behavior comprises an insurance database storing employee and claims data including workers compensation class for employees of a plurality of insurance groups, one or more insurance processors, an insurance memory in communication with the one or more insurance processors and storing insurance program instructions, and an insurance communications device. One or more of the plurality of insurance groups are selected for participation in the first behavior modification program. One or more employees are selected for participation from the one or more of the plurality of insurance groups selected for participation in the first behavior modification program. A first behavior modification program membership data file is updated for each insurance group and information about the behavior modification program is transmitted to the groups selected for participation.

Abstract: An aspect of the present disclosure facilitates importing of tested objects into benefit programs deployed on a production system. In one embodiment, a digital processing system receives a first data representing tested objects to be imported to the production system and a second data indicating whether or not to reuse any of already deployed objects in the production system. The digital processing system imports the tested objects into the production system based on the details of the first data, second data and the already deployed objects in the production system.

Abstract: A computer implemented method including populating a data structure, stored on a computer readable storage device, with data for use in determining eligibility for benefits from a benefits program, performing a verification check on the data using evidence related to the data, making a decision regarding eligibility for benefits based on the verified data and rules for the benefits program, and storing the data utilized in the decision, including the evidence used in the verification check.

Abstract: The present invention is a computer implemented method and system for gathering information from a user related to, filing for, and obtaining government benefits, such as Social Security benefits. The present invention also enables the user to track the benefit application approval process and reminders when certain data or responses are due. There is a feature which enables the user to modify the data submitted for the benefits when circumstances warrant. There is also a decision appeal process feature.

Abstract: A method and computer program product for integrating risk management concepts into a standard business process metamodel by defining a set of metamodel extensions to standard process modeling languages that incorporate risk information directly in the process model. The method includes collecting risk-relevant information for addition to a business process model, and enabling visualizing of a risk-extended business process model. using a notation to express notions as failure modes of resources, root cause events, and sources of execution failure and low job output quality directly in the context of process models. Additionally, the method enables the computation of risk-related impacts on the distribution of process performance measures using a Bayesian network model or a discrete-event simulation model.

Abstract: In embodiments of the present invention improved capabilities are described for a human resource management platform that includes applications targeted to solve a variety of human resource and benefits administration management problems. Applications of the human resource management platform include business applications such as benefits administration that may provide a single solution for facilitating employee benefits management and organizational efficiencies through automation of benefit management functions, measurement of benefit provider effectiveness, and the like.

Abstract: A system and method for assisting companies and employers in complying with various laws, rules and regulations regarding employee health care benefits and insurance plans, specifically including the Affordable Care Act. In one embodiment, web-based software is programmed to receive data from an employer on a regular basis, and then uses the data to make certain determinations regarding employee eligibility for health care benefits, to provide alerts to employers, and to generate reports. The software is programmed to notify the employer regarding crucial deadlines, changes in status of employees that may trigger health care plan eligibility, and alert the employer when steps must be taken for the employer to maintain compliance with such laws, rules and regulations.

Abstract: In embodiments of the present invention improved capabilities are described for a human resource management platform that includes applications targeted to solve a variety of human resource and benefits administration management problems. Applications of the human resource management platform include business applications such as benefits administration that may provide a single solution for facilitating employee benefits management and organizational efficiencies through automation of benefit management functions, measurement of benefit provider effectiveness, and the like.

Abstract: In embodiments of the present invention improved capabilities are described for a human resource management platform that includes applications targeted to solve a variety of human resource and benefits administration management problems. Applications of the human resource management platform include business applications such as benefits administration that may provide a single solution for facilitating employee benefits management and organizational efficiencies through automation of benefit management functions, measurement of benefit provider effectiveness, and the like.

Abstract: In embodiments of the present invention improved capabilities are described for a human resource management platform that includes applications targeted to solve a variety of human resource and benefits administration management problems. Applications of the human resource management platform include business applications such as benefits administration that may provide a single solution for facilitating employee benefits management and organizational efficiencies through automation of benefit management functions, measurement of benefit provider effectiveness, and the like.

Abstract: In embodiments of the present invention improved capabilities are described for a human resource management platform that includes applications targeted to solve a variety of human resource and benefits administration management problems. Applications of the human resource management platform include business applications such as benefits administration that may provide a single solution for facilitating employee benefits management and organizational efficiencies through automation of benefit management functions, measurement of benefit provider effectiveness, and the like.

Abstract: In embodiments of the present invention improved capabilities are described for a human resource management platform that includes applications targeted to solve a variety of human resource and benefits administration management problems. Applications of the human resource management platform include business applications such as benefits administration that may provide a single solution for facilitating employee benefits management and organizational efficiencies through automation of benefit management functions, measurement of benefit provider effectiveness, and the like.

Abstract: In embodiments of the present invention improved capabilities are described for a human resource management platform that includes applications targeted to solve a variety of human resource and benefits administration management problems. Applications of the human resource management platform include business applications such as benefits administration that may provide a single solution for facilitating employee benefits management and organizational efficiencies through automation of benefit management functions, measurement of benefit provider effectiveness, and the like.

Abstract: In embodiments of the present invention improved capabilities are described for a human resource management platform that includes applications targeted to solve a variety of human resource and benefits administration management problems. Applications of the human resource management platform include business applications such as benefits administration that may provide a single solution for facilitating employee benefits management and organizational efficiencies through automation of benefit management functions, measurement of benefit provider effectiveness, and the like.

Abstract: System and method for managing insureds' benefits information, comprising a “benefits vault” database that stores data of insured parties, their respective benefit choices, financial contributions to the vault, and restrictions on the use of the contributions, a rules engine that associates the benefit choices with the respective insureds in accordance with predetermined criteria, a remote benefits engine that accesses remote third party resources to implement the benefit choices, and a reporting engine that provides confirmation of the implementation.

Abstract: In embodiments of the present invention improved capabilities are described for a human resource management platform that includes applications targeted to solve a variety of human resource and benefits administration management problems. Applications of the human resource management platform include business applications such as benefits administration that may provide a single solution for facilitating employee benefits management and organizational efficiencies through automation of benefit management functions, measurement of benefit provider effectiveness, and the like.

Abstract: Systems and methods are described for scoring consumers' credit risk by determining consumers' income risk and future ability to pay. Methods are provided for measuring consumers' income risk by analyzing consumers' income loss risk, income reduction risk, probability of continuance of income, and economy's impact on consumers' income. In one embodiment, a method is provided to evaluate an individual's creditworthiness using income risk based credit score thereby providing creditors, lenders, marketers, and companies with deeper, new insights into consumer's credit risk and repayment potential. By predicting consumers' income risk and the associated creditworthiness the present invention increases the accuracy and reliability of consumers' credit risk assessments, results in more predictive and precise consumer credit scoring, and offers a new method of rendering a forward-looking appraisal of an individual's ability to repay a debt or the ability to pay for products and services.

Abstract: A computer system and method is disclosed for collecting resource rate information associated with a plurality of resource profiles and providing resource rate statistical data for a specific resource profile via a web-based interface. Each resource profile is defined from hierarchical profile selections to identify a job category, and each job category has one or more skills associated therewith. A database maintains the resource profiles and associated resource rate information. The resource rate information is collected from a variety of sources, including business entities that interface with the database to upload actual resource rate information (e.g., actual salaries, wage rates and other compensation information) for one or more resource profiles associated with the business entity.

Abstract: The present invention relates to a system, method and computer-readable storage medium for managing the process of claims benefits. The system comprises an electronic device configured to display on a screen of the electronic device a plurality of steps to be completed by a claimant, the steps being related to the process of filing the claim for benefits. The electronic device is also configured to receive input via an interface of the electronic device indicating that a selected one of steps has been completed by the claimant and to display on the screen a visual indication that the selected step has been completed. The electronic device is also configured to provide information to help the claimant complete at least one of the steps.

Abstract: A system and method for automated coding and testing of insurance benefits is provided. The system comprises a user interface to receive data pertaining to benefits based on insurance benefits contracts and to create Benefit Plan Designs (BPDs) using the received data. The system further comprises a benefits mapping module to map the benefits from the BPDs with pre-stored benefits in a repository. Further, the system comprises a benefit code translator to translate the mapped benefits into codes or mnemonics and a benefit code updating engine to update the codes or mnemonics into one or more claims platforms. In addition, the system comprises a test scenario mapping module to generate test claims and expected results and to execute the generated test claims on the one or more claims platforms to generate actual test results. The system also comprises a validation engine to validate the codes or mnemonics.

Abstract: The most preferred embodiments of the present invention comprise one or more structured computerized databases comprising: a set of outcomes, each with a corresponding set of appropriately-expressed eligibility requirements; a set of applications or forms and their corresponding necessary and unique named data elements, or variables, which may or may not relate to the aforementioned set of outcomes; a set of questions corresponding to the set of variables, each question relating to one or more variables; a set of question scripts corresponding to the set of questions, with one script per question; a set of question help prompt scripts corresponding to the set of questions, with one help prompt per question; a set of interview constructs that semantically relate sets of questions; and a subject definition comprised of named locations used to store variables and their corresponding values.

Abstract: A method and system for inegrating an Enterprise Resource Planning (ERP) system with a voluntary benefits source provider to enable a user to select voluntary benefits provided by the voluntary benefits source provider via the ERP system including providing interfacing software between the voluntary benefits source provider and the ERP system.

Abstract: According to some embodiments, a system may receive, from an employee, a request to access a voluntary employee benefit portal. The system may determine an employer associated with the employee and access information about a set of voluntary employee benefit plans associated with determined employer. Information associated with the voluntary employee benefit portal may then be transmitted, and the transmitted information may be customized based at least in part on the information about the set of voluntary employee benefit plans associated with the determined employer.

Abstract: A computer system and computer-implemented method are provided for management of employee leave and absence policies. The system is configured to receive data related to an employee leave claim at a single point of contact. The single point of contact may be implemented as a single address for leave issues related to any type of leave, including for example for employment-related injuries compensated through workers compensation, short term disability, long-term disability, and other types of leave. The system may be configured to provide prompts to a user for claims relating to multiple types of leave. The system may be configured to furnish data to separate computer systems for administration of multiple types of leave. The system may be configured to provide communications related to employee leave claims between separate computer systems responsive to receipt of data from one or more of the computer systems.

Abstract: The invention relates, in various aspects, to systems, methods, and computer readable media suited for managing employee leave. A processor is configured to receive, from a user-accessible device, via a computer communications network, data relating to at least one claim for a first type of employee leave and also receive data to initiate at least one claim for a second type of employee leave. Thereupon, the data corresponding to the first type of employee leave and the data corresponding to the second type of employee leave are combined and reconciled. There is facilitated a determination of at least one modified leave parameter based on the combined and reconciled data, and the at least one modified leave parameter is stored in a memory storage device.

Abstract: 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.

Abstract: One example embodiment relates to a method that comprises receiving a listing of wellness providers from a wellness program operator, the listing identifying wellness providers each offering a wellness service and being located within a region geographically proximate to a predetermined geo-location; authorizing a subset of the wellness providers to form part of an employee health benefit program; and presenting the subset of authorized wellness providers to an employee.

Abstract: One example embodiment relates to a method that comprises offering a wellness service; enrolling in a listing of wellness providers to be provided to an employer, the listing identifying wellness providers located within a region geographically proximate to a geo-location of the employer or an employee of the employer; receiving authorization from the employer to form part of an employee wellness program as a wellness provider; and reporting, to the employer, use by the employee of the wellness service.

Abstract: An employee benefit administration system and transform method for creating a defined contribution health care benefit. The system comprising: a Dual-Purpose Profit Sharing Plan; means for processing employee records for each of a plurality of employees, and for manipulating employee demographic data, personal data, employment data, payroll data, enrollment data, transaction data with employer plan data to account for plan activity over a predetermined time and to report compliance with relevant IRS Tax Code provisions; and means for storing the employee records and the manipulated data.

Abstract: The current invention is for a system and method for providing “concierge” services to beneficiaries of a covered person provided immediately after death; and for providing “concierge” services to claimants of dismemberment, and continuing throughout the duration of the benefits claim process. The method for this service is offered to the employees and dependents insured through corporate sponsored group life and accident insurance programs. The method includes filing, handling and expediting insurance benefit claims and payouts; corporate sponsored retirement programs and stock benefits transfer, or “roll-over”, to an Individual Retirement Account; handling employee death related communications, paperwork and processing; and providing financial counseling.

Abstract: The present invention provides analytic utilities to an employer or health plan administrator as the financial underwriter of medical, prescription drug, and disability income protection for employees. It is specifically designed to integrate the use of evidence based clinical performance data and prescription drug possession ratios as part of a network optimization application; provide insights into disease progression and population migration over multiple time periods; calculate the impact on productivity as result of risk levels and health conditions; and make available advanced financial modeling capabilities utilizing econometric models and simulation.

Abstract: An aspect of the present invention facilitates assessing extent of completeness of setup of benefits programs for an enterprise. In one embodiment, a digital processing system in response to receiving (from an administrator of the enterprise) data indicating a benefit program identifies the benefit options contained in the indicated benefits program. The system then determines whether each of the identified benefit options has any violations in the corresponding setup. The system then computes a score for the benefits programs based on the determination, with the score representing an extent of completeness of setup of the indicated benefits program. The computed score is then provided (to the administrator) as a response to the receiving of the data.

Abstract: An automatic sales tax declaration system includes a control center, a point of sale (POS) terminal at a shop, a declaration machine accessible to a customer, and a tax declaration card. The POS terminal and the declaration machine both communicate with the control center via a mobile telecommunication network. When a sale is made, the merchant collects the payment using the POS terminal, which records customer tax information on the tax declaration card and transmits merchant tax information to the control center. Subsequently, the customer uses the tax declaration card and the declaration machine to transmit the customer tax information to the control center. The control center calculates the sales tax based on the customer and merchant tax information. If the control center does not receive merchant tax information corresponding to the customer tax information, it concludes that the merchant may have attempted to conceal sales and evade taxes.

Abstract: A computer system and computer-implemented method are provided for management of employee leave and absence policies. The system is configured to receive data related to an employee leave claim at a single point of contact. The single point of contact may be implemented as a single address for leave issues related to any type of leave, including for example for employment-related injuries compensated through workers compensation, short term disability, long-term disability, and other types of leave. The system may be configured to provide prompts to a user for claims relating to multiple types of leave. The system may be configured to furnish data to separate computer systems for administration of multiple types of leave. The system may be configured to provide communications related to employee leave claims between separate computer systems responsive to receipt of data from one or more of the computer systems.

Abstract: A computer-based method and system to enable a benefit plan sponsor to design a plurality of benefit plans to be offered to a given participant population and for determining the cost of sponsoring the plans for the participant population by predicting utilization for each of the plans based upon historical utilization data for the population, projected plan selections based upon presumed participant objectives, and/or survey or historical data from a sample of the given population or from preexisting statistical samples exhibiting analogous demographic characteristics to the given participant population relating to expected benefit utilization and plan preference criteria.

Abstract: A method and system to provide benefits to employees or other users associated with an organization, where the benefits are discounted goods and services is described. The system may involve a benefits provider that coordinates the program. The system may be effected by various computer networks involving databases.