Cluster of correlated medical claims in an episode treatment group

• US 20020173988A1
• Filed: 03/25/2002
• Published: 11/21/2002
• Est. Priority Date: 06/22/1995
• Status: Abandoned Application

• Current Assignee: Symmetry Health Data Systems Incorporated (UnitedHealth Group Incorporated)
• Original Assignee: Symmetry Health Data Systems Incorporated (UnitedHealth Group Incorporated)
• Inventors: Dang, Dennis K.
• Application Number:
  US10/106,282
• Publication Number:
  US 20020173988A1
• Time in Patent Office: Days
• US Class Current: 705/2
• CPC Class Codes: G06Q 10/087 Inventory or stock management, e.g. order filling, procurement or balancing against orders
• CPC Class Codes: G06Q 30/02 Marketing; Price estimation or determination; Fundraising
• CPC Class Codes: G06Q 40/02 Banking, e.g. interest calculation or account maintenance credit or loans G06Q40/03
• CPC Class Codes: G06Q 40/08 Insurance
• CPC Class Codes: G16H 40/67 for remote operation
• CPC Class Codes: G16H 70/40 relating to drugs, e.g. their side effects or intended usage

Abstract

A computer-implemented method for profiling medical claims to assist health care managers in determining the cost-efficiency and service quality of health care providers. The method allows an objective means for measuring and quantifying health care services. An episode treatment group (ETG) is a patient classification unit which defines groups that are clinically homogenous (similar cause of illness and treatment) and statistically stable. The ETG grouper methodology uses service or segment-level claim data as input data and assigns each service to the appropriate episode. The program identifies concurrent and recurrent episodes, flags records, creates new groupings, shifts groupings for changed conditions, selects the most recent claims, resets windows, makes a determination if the provider is an independent lab and continues to collect information until an absence of treatment is detected.

Claims

1. A cluster of correlated medical services rendered to a single medical patient, characterized by a plurality of data bits defining a patient'"'"'s data record recorded on a machine readable carrier, and encoding a cluster value identifying a cluster to which the patient'"'"'s data record is correlated.

2. An episode treatment group characterized by one or more digital identifiers according to claim 1.