Patent ID: 8825504

Claim:
A method for modifying benefit coverage including a plurality of benefit codes of a selected insurance plan of a plurality of insurance plans, the selected insurance plan for use in adjudicating one or more insurance claims, the method comprising the steps of: accessing, using a computer processor, a set of benefit codes structured in a plurality of benefit containers stored in a memory; providing a primary benefit container; providing a plurality of secondary benefit containers, 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; providing a plurality of benefit references to couple each of the one or more benefit codes to their respective secondary benefit container by a respective benefit reference; providing a plurality of benefit container references to couple each of the plurality of secondary benefit containers to the primary benefit container by a respective benefit container reference, wherein the respective benefit container references and the respective benefit references define a benefit hierarchy of the set of benefit codes that can be reused across the plurality of insurance plans; selecting, using the computer processor, the primary benefit container for inclusion in the selected insurance plan; modifying the selected insurance plan, using the computer processor, by modifying a benefit container parameter of at least one of the benefit container references; storing the modified selected insurance plan in the memory accessible by the computer processor, wherein the stored modified insurance plan is adapted for subsequent use in adjudication of appropriate insurance claims received by an adjudication system; and accessing a set of adjudication rules structured in a plurality of containers including a primary rule container and a plurality of secondary rule containers, each of the plurality of secondary rule containers being coupled to the primary rule container by a respective container reference, each of the plurality of 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.