METHOD AND SYSTEM FOR PROVIDING REPORTS AND SEGMENTATION OF PHYSICIAN ACTIVITIES

• US 20100114607A1
• Filed: 06/09/2009
• Published: 05/06/2010
• Est. Priority Date: 11/04/2008
• Status: Abandoned Application

• Current Assignee: Quintiles IMS Incorporated (IQVIA Holdings, Inc.)
• Original Assignee: SDI Health LLC (IQVIA Holdings, Inc.)
• Inventors: Fisher, Jody, KRESS, Andrew E., Rosztoczy, Steven
• Application Number:
  US12/481,321
• Publication Number:
  US 20100114607A1
• Time in Patent Office: Days
• US Class Current: 705/3
• CPC Class Codes: G06Q 10/06 Resources, workflows, human or project management; Enterprise or organisation planning; Enterprise or organisation modelling
• CPC Class Codes: G16H 40/20 for the management or administration of healthcare resources or facilities, e.g. managing hospital staff or surgery rooms
• CPC Class Codes: G16H 40/67 for remote operation

Abstract

A system includes a database with at least one dataset with at least one data field corresponding to at least one field of data of a medical claim form, a computing platform in communication with the database, and a memory module. The at least one dataset is formed from de-identified provider information. The memory module contains at least one conversion table for converting between a provider identification code and a corresponding provider name. The computing platform receives a request for information, extracts from the database one or more datasets having information responsive to the request, and forms an output table based on the extracted one or more datasets. The table includes the provider name.

Claims

1. A system comprising:

a database containing at least one dataset with at least one data field corresponding to at least one field of data of a medical claim form, the at least one dataset formed from de-identified provider information;

a computing platform in communication with the database; and

a memory module in communication with the computing platform, the memory module containing at least one conversion table for converting between a provider identification code and a corresponding provider name,

wherein the computing platform receives a request for information, extracts from the database one or more datasets having information responsive to the request, and forms an output table based on the extracted one or more datasets, the output table having the provider name.

2. The system according to claim 1, wherein the database forms the at least one dataset from the at least one field of data of the medical claim form.

3. The system according to claim 1, wherein the computing platform searches the database for a particular diagnosis code.

4. The system according to claim 1, wherein the computing platform searches the database for a particular procedure code.

5. The system according to claim 1, wherein the output table further includes at least one of a diagnosis code, a procedure code, market volume, location of care, patients by age, or payer information.

6. The system according to claim 1, wherein the medical claim form includes patient information, procedure information, diagnosis information, and

wherein the output table further includes at least one of the patient information, the procedure information, or the diagnosis information.

7. The system according to claim 1, wherein the computing platform filters the extracted one or more datasets according to at least one of a period of time, a geographic location, a location of care, or a specialty of medicine.

8. The system according to claim 1, wherein the database communicates with a clearinghouse that receives the medical claim form.

9. The system according to claim 1, further comprising a reference database in communication with the computing platform, the reference database containing at least one lookup table for converting between a diagnosis code and a corresponding diagnosis and for converting between a procedure code and a corresponding procedure code.

10. The system according to claim 1, wherein the de-identified provider information does not contain the provider name.

11. A method of providing an output of providers, the method comprising the steps of:

obtaining a medical claim form with a provider identification code and at least one field of data;

forming a dataset with a plurality of data fields;

relating one of the plurality of data fields with the provider identification code;

relating another one of the plurality of data fields with the at least one field of data of the medical claim form;

searching the dataset for a particular entry in the at least one data field;

extracting one or more datasets with a substantially matching entry;

converting provider identification codes of the one or more extracted datasets into a provider name; and

providing an output table with the one or more provider names formed from the one or more extracted datasets.

12. The method according to claim 11, wherein the step of searching the dataset for a particular entry in the at least one data field further comprises searching the dataset for a particular diagnosis code.

13. The method according to claim 11, wherein the step of searching the dataset for a particular entry in the at least one data field further comprises searching the dataset for a particular procedure code.

14. The method according to claim 11, wherein the step of providing an output table with the one or more provider names formed from the one or more extracted datasets further comprises:

providing the output table with at least one of a diagnosis code, a procedure code, market volume, location of care, patients by age, or payer information.

15. The method according to claim 11, further comprising the step of filtering the extracted one or more datasets according to at least one of a period of time, a geographic location, a location of care, or a specialty of medicine.

16. The method according to claim 11, further comprising the step of converting between a diagnosis code and a corresponding diagnosis.

17. The method according to claim 11, further comprising the step of converting between a procedure code and a corresponding procedure code.

18. The method according to claim 11, wherein the step of obtaining a medical claim form with a provider identification code and at least one field of data further comprises:

communicating with a clearinghouse.

19. A system providing an output table, the system comprising:

a database containing a plurality of datasets, each of the plurality of datasets including a plurality of data fields, each of the plurality of data fields corresponding to one of a plurality of fields of data of a medical claim form, the database being in communication with a clearinghouse that receives a plurality of medical claim forms, each of the plurality of medical claim forms including a provider identification code in one of the plurality of fields of data;

a processor in communication with the database; and

a memory module in communication with the computing platform, the memory module containing at least one conversion table for converting between the provider identification code and a corresponding provider name,

wherein the processor receives a request for information, extracts from the database one or more datasets having information responsive to the request, converts the provider identification code of the one or more extracted datasets into a provider name, and forms an output table based on the extracted one or more datasets, and

wherein the output table includes the one or more provider names arranged according to the occurrence of the particular entry in the medical claim forms submitted by the providers.