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Method and system for grouping medical claims

  • US 10,535,430 B1
  • Filed: 07/25/2014
  • Issued: 01/14/2020
  • Est. Priority Date: 07/25/2014
  • Status: Active Grant
First Claim
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1. A method for grouping medical claims data from a plurality of data sources comprising:

  • receiving from the plurality of data sources, at a processor, a plurality of medical claims data records each comprising a plurality of data fields;

    sorting, at the processor, the plurality of medical claims data records by at least one grouping scheme, wherein the at least one grouping scheme examines at least one data field in each of the plurality of medical claims data records;

    building, at the processor, at least one dateblock from the plurality of medical claims data records, wherein building the at least one dateblock comprises;

    examining a patient data field and a date data field in each of the plurality of medical claims data records and grouping the medical claims data records together by a first patient and a first date; and

    sorting, by the first date, the medical claims data records grouped by the first patient into the at least one dateblock;

    prioritizing, at the processor, within the at least one dateblock, the medical claims data records according to the at least one grouping scheme to identify a first priority medical claims data record, wherein a procedure associated with the first priority medical claims data record comprises an anchor procedure for a first medical event;

    assigning, by the processor, a match level to each medical claims data record in the set of remaining medical claims data records grouped by the first patient, wherein the match level is selected from a plurality of match levels based on a plurality of matching factors;

    matching, by the processor, each medical claims data record in the set of the remaining medical claims data records to a set of the remaining medical claims data records that match the anchor procedure for the first medical event when the assigned match level is above a threshold probability level indicating that the medical claims data records are related to the anchor procedure for the medical event, wherein the probability level is derived from the strength of at least one observed relationship between medical claims data in a set of historical medical claims data;

    building, at the processor, within the at least one dateblock, the first medical event, wherein the first medical event comprises the first priority medical claims data record and the set of the remaining medical claims data records that match the anchor procedure for the first medical event; and

    applying, by the processor, the first medical event to a healthcare system analysis.

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