Apparatus, system and method for member matching

• US 8,359,337 B2
• Filed: 12/09/2009
• Issued: 01/22/2013
• Est. Priority Date: 12/09/2008
• Status: Active Grant

• Current Assignee: Optuminsight, Inc. (UnitedHealth Group Incorporated)
• Original Assignee: Ingenix Incorporated (UnitedHealth Group Incorporated)
• Inventors: Anumakonda, Ravi, Paulinski, Dawn, Buchanan, Laurie A., Dunn, Dan
• Primary Examiner(s): HASAN, SYED HAROON
• Application Number:
  US12/634,067
• Publication Number:
  US 20100174688A1
• Time in Patent Office: 1,140 Days
• Field of Search: None
• US Class Current: 707/802
• CPC Class Codes: G06F 16/215 Improving data quality; Data cleansing, e.g. de-duplication, removing invalid entries or correcting typographical errors
• CPC Class Codes: G06F 16/2455 Query execution

Abstract

An apparatus, system, and method for member matching. In one embodiment, the apparatus includes an input adapter, a processor, and an output adapter. The input adapter may receive a first data record from a plurality of data records stored in one or more databases. The processor may generate a first data key from one or more field values in the first data record, compare a second data key associated with a second data record with the first data key associated with the first data record, and identify a match between the first data key and the second data key. In one embodiment, the output adapter may produce an output configured to identify the first data record and the second data record in response to identification of the match.

Claims

1. An apparatus comprising:

an input adapter configured to receive a first health care data record from a first health care plan and a second health care data record from a second health care plan from a plurality of health care data records stored in one or more databases, where each of the first and second health care data records comprises a plurality of field values;

a processor coupled to the input adapter, the processor configured to;

generate a plurality of first data keys, where each first data key corresponds to a predetermined combination of at least two field values in the first health care data record;

generate a plurality of second data keys, where each second data key corresponds to a predetermined combination of at least two field values in the second health care data record;

compare the plurality of second data keys to the plurality of first data keys;

assign a first identifier to the first and second health care data records, if a match between the plurality of first data keys and the plurality of second data keys is identified; and

assign a second identifier to the first and second health care data records, if no match between the plurality of first data keys and the plurality of second data keys is identified; and

an output adapter coupled to the processor, the output adapter configured to produce an output in response to the comparison result.

2. The apparatus of claim 1, where the processor is further configured to clean the first health care data record and the second health care data record before comparing the first data key and the second data key.

3. The apparatus of claim 1, where the processor is further configured to standardize the first and second health care data records before comparing the first data key and the second data key.

4. The apparatus of claim 3, wherein standardizing the first and second health care data records comprises assigning a same encrypted value to a plurality of variables which represent a same field value.

5. The apparatus of claim 1, where comparing the plurality of first data keys and the plurality of second data keys further comprises:

sequentially comparing each first data key to a second data key; and

terminating the comparison once a match is identified.

6. The apparatus of claim 1, where the first identifier comprises a common identifier associating the first health care data record and the second health care data record with a unique entity.

7. A system comprising:

one or more data storage devices configured to store a plurality of health care data records from one or more health care plans; and

a server in data communication with the data storage device, the server configured to;

receive a first health care data record from a first health care plan and a second health care data record from a second health care plan from the plurality of health care data records stored in one or more databases located on the one or more data storage devices, where each of the first and second health care data records comprises a plurality of field values;

generate a plurality of first data keys, where each first data key corresponds to a predetermined combination of at least two field values in the first data record;

generate a plurality of second data keys, where each second data key corresponds to a predetermined combination of at least two field values in the second health care data record;

compare the plurality of second data keys with the plurality of first data keys;

assign a first identifier to the first health care data record and second health care data record, if a match between the plurality of first data keys and the plurality of second data keys is identified;

assign a second identifier to the first and second health care data records, if no match between the plurality of first data keys and the plurality of second data keys is identified; and

produce an output in response to the comparison result.

8. The system of claim 7, where the server is further configured to clean the first health care data record and the second health care data record before comparing the first data key and the second data key.

9. The system of claim 7, where the server is further configured to standardize the first and second health care data records before comparing the first data key and the second data key.

10. The system of claim 9, wherein standardizing the first and second health care data records comprises assigning a same encrypted value to a plurality of variables which represent a same field value.

11. The system of claim 7, where comparing the plurality of first data keys and the plurality of second data keys further comprises

sequentially comparing each first data key to a second data key;

and

terminating the comparison once a match is identified.

12. The system of claim 7, where the first identifier comprises a common identifier associating the first health care data record and the second health care data record with a unique entity.

13. A tangible computer program product comprising a non-transitory computer readable storage medium having computer usable program code executable to perform operations comprising:

receiving a first health care data record from a first health care plan and a second health care data record from a second health care plan from a plurality of health care data records stored in one or more databases, where each of the first and second health care data records comprises a plurality of field values;

generating a plurality of first data keys, where each first data key corresponds to a predetermined combination of at least two field values in the first data record;

generating a plurality of second data keys, where each second data key corresponds to a predetermined combination of at least two field values in the second health care data record;

comparing the plurality of second data keys with the plurality of first data keys;

assigning a first identifier to the first and second health care data records, if a match between the first plurality of data keys and the plurality of second data keys is identified;

assigning a second identifier to the first and second health care data records, if no match between the plurality of first data keys and the plurality of second data keys is identified; and

producing an output in response to the comparison result.

14. The tangible computer program product of claim 13, the operations comprising cleaning the first health care data record and the second health care data record before comparing the first data key and the second data key.

15. The tangible computer program product of claim 13, the operations comprising standardizing the first and second health care data records before comparing the first data key and the second data key.

16. The tangible computer program product of claim 15, wherein standardizing the first and second health care data records comprises assigning a same encrypted value to a plurality of variables which represent a same field value.

17. The tangible computer program product of claim 13, where the operation for comparing the plurality of first data keys and the plurality of second data keys further comprises

sequentially comparing each first data key to a second data key;

and

terminating the comparison once a match is identified.

18. The tangible computer program product of claim 13, the first identifier comprising a common identifier associating the first health care data record and the second health care data record with a unique entity.

19. A method comprising:

receiving a first health care data record from a first health care plan and a second health care data record from a second health care plan from a plurality of health care data records stored in one or more databases, where each of the first and second health care data records comprises a plurality of field values;

generating a plurality of first data keys, where each first data key corresponds to a predetermined combination of at least two field values in the first health care data record;

generating a plurality of second data keys, where each second data key corresponds to a predetermined combination of at least two field values in the second health care data record;

comparing the plurality of second data keys with the plurality of first data keys;

identifying a match between the plurality of first data keys and the plurality of second data keys; and

assigning a first identifier to the first health care data record and to the second health care data record, if a match between the first plurality of data keys and the plurality of second data keys is identified;

assigning a second identifier to the first health care data record and to the second health care data record, if no match between the plurality of first data keys and the plurality of second data keys is identified; and

producing an output in response to the comparison result.

20. The method of claim 19, comprising cleaning the first health care data record and the second health care data record before comparing the first data key and the second data key.

21. The method of claim 19, comprising standardizing the first and second health care data records before comparing the first data key and the second data key.

22. The method of claim 21, wherein standardizing the first and second health care data records comprises assigning a same encrypted value to a plurality of variables which represent a same field value.

23. The method of claim 19, where comparing the plurality of first data keys and the plurality of second data keys further comprises

sequentially comparing each first data key to a second data key;

and

terminating the comparison once a match is identified.

24. The method of claim 19, the first identifier comprising a common identifier associating the first health care data record and the second health care data record with a unique entity.