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health-payer-admin

health-plan claims adjudication and benefits administration

HealthEdge, TriZetto Facets, Cognizant QNXT

SystemTechniques · 17Primitives · 65 health-payer-admin Batch checkpoint restartdistributed · medium: Large batch jobs (end-of-day, settlement, payroll runs) that checkpoint and restart idempotentlyDurable workflow executiondistributed · medium: Ordinary code made crash-proof by logging every side-effect result and replaying the code from that log; activities run at least once, workflow logic must be deterministic.›Payment state machinefinance · medium: Persisted state machine for a payment lifecycle (authorize, capture, void, refund) that treats timeouts as unknown, retries with the same key and applies webhooks idempotently.›Tariff ratingfinance · medium: Rate usage events against price plans: tiers, time bands, bundles and rounding rulesGradient-boosted decision trees (GB…machine-learning · medium: Add small regression trees one at a time, each fitted to the loss gradient; histogram splits over 256 bins make it the strongest tabular default.›Terminology code systemsnetworking · medium: Code systems, value sets and concept maps (SNOMED CT, LOINC, ICD) with subsumption queriesRecord linkagesearch-sort · medium: Probabilistic record matching (Fellegi-Sunter) with blocking for patient or entity indexesInterval treedata-structures · low: Index of ranges that answers "which intervals overlap this point or range?" in O(log n + k); static sorted-array form is the compact, cache-friendly choice.›Money representationfinance · low: Store money as integer minor units with an explicit currency exponent, compute in wider integers, and round once with a named rounding mode.›Fhir resource modelnetworking · low: FHIR resources, references, search parameters and REST interactions for health data exchangeBenefit accumulatorseconomics · low: Track deductible and out-of-pocket accumulators per member and plan year, applying them in order to split claims into plan and member sharesDouble-entry ledgerfinance · low: Append-only journal of transactions whose postings sum to zero per currency; balances are derived, so money can only move, never appear or vanish.›Reconciliationfinance · low: Match internal ledger records against bank and processor statements by reference, then amount and date window; every unmatched or mismatched item becomes an exception.›X12 edi messagingnetworking · low: ANSI X12 and EDIFACT interchanges: segment/element delimiters, ISA/GS/ST envelopes, control numbers and 997/CONTRL acknowledgementsBusiness day calendarssystems · low: Holiday calendars, business-day adjustment rules (following, modified following) and settlement cyclesIdempotency keysfinance · low: Client-chosen unique key per logical operation, stored with a request fingerprint and the final response, so retries replay the first result instead of acting twice.›Write-ahead logstorage · low: Append each change to a checksummed sequential log and fsync it before touching data pages; the basis of crash durability in nearly every database.›Cron schedulingsystems · low: Cron expression parsing and next-fire-time computation, with catch-up and time-zone rulesRecord replaydistributed · low: Record every nondeterministic input (time, randomness, I/O, model and tool outputs, per-tick player input) and re-execute deterministically for debugging, replays and state rebuildEvent sourcingfinance · low: Persist state changes as an append-only stream of immutable events per entity; current state is a fold over them, guarded by expected-version appends.›Hierarchical timing wheelsystems · low: Timers bucketed by expiry into wheels of slots, coarser wheels for far deadlines: O(1) insert and cancel for millions of timeouts.›Exponential backoff with jittersystems · low: Retry after delays that grow geometrically and are randomized, so failed clients spread out instead of hammering a recovering service in synchronized waves.›Hierarchical state machinesystems · low: Nest states so a substate inherits its parent's reactions and only overrides what differs, with ordered entry and exit actions along the path.›+ 10 more techniques+ 49 more primitives

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