System and Method For Using a First Electronic Representation of Contract Terms For Generating a Second Electronic Representation of the Contract Terms

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.

主权项

1. A method for representing varying terms from insurer payment contracts across multiple software applications comprising:
electronically representing a first insurer contract between the insurer and a first service provider in a contract modeling application in a first format, wherein the insurer contract contains multiple first terms; receiving at the insurer, a first claim for services and first request for payment from the first service provider; responsive to the first claim and request, importing at least first payment terms of the multiple first terms of the first insurer contract from the contract modeling application to a claim adjudication application, wherein the importing includes translating by a first adapter, the first payment terms of the multiple first terms from the first format to a second format recognizable by the claim adjudication application; determining by the claim adjudication application a first amount to be paid to the first service provider responsive to the first claim and request in accordance with the imported first payment terms in the second format; and importing the multiple first terms of the first insurer contract from one of the contract modeling application and the claim adjudication application to a contract management application, wherein the importing includes translating by one of a second adapter and a third adapter, the multiple first terms from one of the first and second formats to a third format recognizable by the contract management application.