Systems and methods for decoding payer identification in health care data records

• US 20050071200A1
• Filed: 07/19/2004
• Published: 03/31/2005
• Est. Priority Date: 07/18/2003
• Status: Active Grant

• Current Assignee: IMS Software Services Ltd. (IQVIA Holdings, Inc.)
• Original Assignee: IMS Software Services Ltd. (IQVIA Holdings, Inc.)
• Inventors: Pennente, Kimberly, James, Mary Kay, Blanton, Ilene, Moyer, Kevin, Franklin, Dave
• Granted Patent: US 7,747,658 B2
• Time in Patent Office: Days
• US Class Current: 705/3
• CPC Class Codes: G06Q 10/02 Reservations, e.g. for tickets, services or events
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G16H 10/60 for patient-specific data, e.g. for electronic patient records
• CPC Class Codes: G16H 20/10 relating to drugs or medications, e.g. for ensuring correct administration to patients
• CPC Class Codes: Y10S 707/941 Human sciences

Abstract

Processing arrangements and methods are provided for the automated decoding or translation of information in healthcare data records, which are coded in a non-standardized or varying formats. A data record which contains information, a portion which is recognized and another portion of which is new, is decoded or translated using a statistical mapping rule. The mapping rule assigns a most likely translation value to the information based on the recognized portion of the information. The statistical mapping rules are established by analysis of a set of previously decoded data records.

Claims

1. A data processing arrangement for decoding new information in health care data records, each data record having a plurality of data fields, the arrangement comprising:

an application for determining an overlap of the new information with the previously decoded information; and

an application for assigning the decoded value of the previously decoded information to the new information that has an overlap with the previously decoded information.

2. The data processing arrangement of claim 1 further comprising a mapping file listing previously decoded information and corresponding decoded values.

3. The data processing arrangement of claim 1 further comprising an application for updating a mapping file listing decoded information and corresponding decoded values.

4. The data processing arrangement of claim 1 further comprising an application for selecting the previously decoded information on a statistical basis.

5. A method for establishing mapping rules for mapping user codes (MR payer IDs) to prescription transaction data records, wherein each data record comprises at least a first, a second and a third data fields, the method comprising:

analyzing a set of previously mapped data records that have been mapped to MR payer fDs based on at least the values of the third data fields;

determining unique combinations of first and second data field values present in the set of previously mapped data records;

for each unique combination of the first and second data field values, determining a MR payer ID that is frequently mapped to the corresponding data records.

establishing a mapping rule assigns the frequently mapped MR payer ID to all data records having the unique combination of the first and second data field values.

6. The method of claim 5, wherein determining a MR payer ID that is frequently mapped to the corresponding data records comprises selecting a MR payer ID that occurs with a frequency greater than a cutoff limit.

7. The method of claim 5, further comprising validating the mapping rule with a data supplier of the data records.

8. The method of claim 5, wherein a mapping rule is assigned only for the unique combinations of the first and second data field values that occur with a frequency greater than a cutoff limit.

9. A data processing arrangement comprising software applications for carrying out the steps of claim 5.

10. A method for assigning user codes (MR payer IDs) to prescription field selected from the group of a bank identification number (BIN) data field, and a Group ID (GID) data field and a data supplier specified payer indicia (DS) data field, and wherein a first subset of the data records have been previously assigned MR payer IDs based on known mappings of the values in their respective DS data fields, and a second subset of data records that have not been assigned MR payer IDs, the method comprising:

for the first subset, extracting data records in which at least one of the BIN and GID fields are populated;

determining the unique combinations of the BIN and GID values present in the first subset;

determining the occurrence frequency of each unique combination of BIN and GID values in the first subset,

selecting only those unique combinations of BIN and GID values that occur with a frequency greater than a cutoff limit X;

for each such selected combination of BIN and GID values determining the frequency distribution of MR payer IDs assigned to corresponding data records in the first subset;

selecting MR payer IDs having an occurrence frequency greater than a cutoff limit Y,

for each such selected MR payer ID, establishing the combination of the BIN and GID values and the selected MR payer ID as a mapping rule for mapping data records in a second subset of data records.

11. The method of claim 10 further comprises validating the mapping rule with a data supplier.

12. The method of claim 10 wherein the data records further comprise an Processor Control Number (PCN) data field, and wherein the combinations of the BIN and GID values comprises a combination of the BIN, GID and PCN values.

13. The method of claim 10 further comprising:

for the second subset, grouping data records by unique combinations of BIN and GID values present in the second subset;

identifying BIN and GID combinations that having mapping rules established by analysis of the first subset of data records; and

,

assigning the grouped data records MR payer IDs according to the mapping rules established by analysis of the first subset of data records.

14. The method of claim 13 wherein the data records further comprise a Processor Control Number (PCN) data field, and wherein the combinations of the BIN and GID values comprises a combination of the BIN, GID and PCN values.

15. The method of claim 10 further comprising:

for the second subset,

grouping data records by unique combinations of BIN and GID values present in the second set;

identifying unique BIN and GID combinations that do not have mapping rules established by analysis of the first subset of data records;

manually verifying the MR payer ID for those data records that do not have matching rules established by analysis of the first subset of data records;

establishing the unique combination of BIN and GID values and the corresponding manually verified MR payer ID as a mapping rule.

16. The method of claim 13 wherein the data records further comprise a Processor Control Number (PCN) data field, and wherein the combinations of the BIN and GID values comprises a combination of the BIN, GID and PCN values.