System and method for grouping claim records associated with a procedure

Patent 7801749 Issued on September 21, 2010. Estimated Expiration Date:

June 7, 2027. Estimated Expiration Date is calculated based on simple USPTO term provisions. It does not account for terminal disclaimers, term adjustments, failure to pay maintenance fees, or other factors which might affect the term of a patent.

Abstract Claims Description Full Text

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Inventors

Assignee

Ingenix, Inc.

Application

No. 11759616 filed on 06/07/2007

US Classes:

705/4Insurance (e.g., computer implemented system or method for writing insurance policy, processing insurance claim, etc.)

Examiners

Primary: Abdi, Kambiz
Assistant: Rosen, Elizabeth H

Attorney, Agent or Firm

DORSEY & WHITNEY LLP

International Class

G06Q 40/00

Abstract

A system and computer-implemented method for grouping medical records implements a multi-level analysis of the records. The level of analysis for each record is determined based upon the time proximity of each record to the defining medical procedure or service (anchor procedure) to be analyzed. Once an anchor procedure is identified, claim records are processed to determine whether any of the records should be grouped with the anchor procedure into a procedure episode group (PEG). First, the date of service for each claim record is identified to determine whether the claim record falls within time window. The claim records falling within the window then are assessed to determine whether each claim record is sufficiently related to the anchor procedure (for example, by determining whether the diagnostic, procedure, or episode treatment group coding of each claim record is associated with the anchor procedure). The requisite level of relationship between the claim records and the anchor procedure depends upon the position of the records within the time window. Only those claim records having the requisite relationship level associated with the portion of the time window in which they fall are included in the PEG.

Other References

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