Systems and methods for decoding payer identification in health care data records
First Claim
1. 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 assigned MR payer IDs 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 data records;
for each unique combination of the first and second data field values, determining a MR payer ID that is frequently assigned to the corresponding data records, wherein the frequency of assignment is above a cutoff limit value;
establishing a mapping rule that assigns the frequently mapped MR payer ID to all data records having the unique combination of the first and second data field values;
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.
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Accused Products
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.
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Citations
10 Claims
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1. 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:
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analyzing a set of previously mapped data records that have been assigned MR payer IDs 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 data records; for each unique combination of the first and second data field values, determining a MR payer ID that is frequently assigned to the corresponding data records, wherein the frequency of assignment is above a cutoff limit value; establishing a mapping rule that assigns the frequently mapped MR payer ID to all data records having the unique combination of the first and second data field values; 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. - View Dependent Claims (2, 3)
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4. A method for assigning user codes (MR payer IDs) to prescription transaction data records fields 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:
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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. - View Dependent Claims (5, 6, 7, 8, 9, 10)
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Specification