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 comprising:
creating a first electronic representation of contract terms on a system, wherein said first electronic representation of the contract terms has a first format that is compatible with at least a first application which includes a claim adjudication application, and wherein said electronically represented terms are configured to be processed by said claim adjudication application to determine an amount of payment by said insurer responsive to a submitted claim, further wherein said first electronic representation associates at least one qualifier and a corresponding calculation method with each payment term of the contract; determining priority of applicability amongst multiple contract terms when the at least one qualifier of more than one contract term is met; and using, by said system, the first electronic representation of contract terms to generate at least a portion of a second electronic representation of the contract, wherein said second electronic representation of the contract has a second format that is compatible with at least a second application.