Analyzing administrative healthcare claims data and other data sources

• US 7,917,525 B2
• Filed: 12/06/2006
• Issued: 03/29/2011
• Est. Priority Date: 12/06/2005
• Status: Active Grant

• Current Assignee: Ingenix Incorporated (UnitedHealth Group Incorporated)
• Original Assignee: Ingenix Incorporated (UnitedHealth Group Incorporated)
• Inventors: Rawlings, Jean, Paris, Andrew, Anderson, David, Kraus, Carl
• Primary Examiner(s): Cottingham; John R.
• Assistant Examiner(s): Rayyan; Susan F
• Application Number:
  US11/567,577
• Publication Number:
  US 20070174252A1
• Time in Patent Office: 1,574 Days
• Field of Search: 707 1- 3
• US Class Current: 707/758
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 40/08 Insurance
• CPC Class Codes: G16H 10/20 for electronic clinical trials or questionnaires
• CPC Class Codes: G16H 15/00 ICT specially adapted for medical reports, e.g. generation or transmission thereof
• CPC Class Codes: G16H 50/70 for mining of medical data, e.g. analysing previous cases of other patients
• CPC Class Codes: Y02A 90/10 Information and communication technologies [ICT] supporting adaptation to climate change, e.g. for weather forecasting or climate simulation
• CPC Class Codes: Y10S 707/941 Human sciences

Abstract

Techniques suitable for identifying potential subjects for a clinical trial and other applications are disclosed. One or more exclusion or inclusion criteria are defined for the clinical trial. One or more specialized searching tables are pre-generated using administrative healthcare claims data and the one or more exclusion or inclusion criteria. The specialized searching tables are searched. Through the searching step, subjects are identified within the administrative healthcare claims data who match the one or more exclusion or inclusion criteria. Through the searching step, a geographical area is identified corresponding to the subjects who match the one or more exclusion or inclusion criteria. A customized report is generated using the identified subjects and geographical area.

Claims

1. A non-transitory computer readable medium comprising computer executable instructions embodied therein that when executed carry out a method comprising:

searching administrative healthcare claims data; and

comparing one subset of the administrative healthcare claims data against a plurality of other subsets of the administrative healthcare claims data; and

calculating a hypergeometric statistical result based on the comparing step using one or more pre-generated factorial tables, the factorial tables comprising logarithmic entries.

2. The non-transitory computer readable medium of claim 1, where calculating comprises one or more calculations using the logarithmic entries followed by one or more exponential operations.

3. The non-transitory computer readable medium of claim 1, further comprising using the hypergeometric statistical result to detect medical-related fraud.

4. The non-transitory computer readable medium of claim 3, where the one subset comprises medical coding data associated with a first physician and the plurality of other subsets comprises medical coding data associated with a plurality of other physicians.

5. The non-transitory computer readable medium of claim 4, where the plurality of other physicians are selected to be within the same specialty as the first physician.

6. The non-transitory computer readable medium of claim 5, further comprising generating a customized report comparing the first physician versus the plurality of other physicians.

7. The non-transitory computer readable medium of claim 6, the customized report comprising a graph of utilization percentage versus medical code for the first physician and the plurality of other physicians.

8. The non-transitory computer readable medium of claim 1, further comprising using the hypergeometric statistical result to rate one physician versus other physicians.

9. The non-transitory computer readable medium of claim 1, further comprising using the hypergeometric statistical result to identify potential subjects for a clinical trial.

10. The non-transitory computer readable medium of claim 1, further comprising using the hypergeometric statistical result to recruit a medical professional for use as an expert witness for litigation.

11. A non-transitory computer readable medium comprising computer executable instructions embodied therein that when executed carry out a method comprising:

pre-generating one or more specialized searching tables using administrative healthcare claims data;

pre-generating one or more factorial tables, the factorial tables comprising logarithmic entries;

searching the specialized searching tables;

identifying, through the searching step, one or more records within the administrative healthcare claims data that matches one or more search criteria;

comparing the one or more records against a plurality of other records of the administrative healthcare claims data;

calculating a hypergeometric statistical result based on the comparing step using the one or more factorial tables; and

generating a customized report using the one or more records and the statistical result.

12. The non-transitory computer readable medium of claim 11, where the one or more search criteria comprise one or more exclusion or inclusion criteria selected using a Venn diagram.

13. The non-transitory computer readable medium of claim 11, where calculating comprises one or more calculations using the logarithmic entries followed by one or more exponential operations.