Patent ID: 11935008
Assignee: MILLIMAN SOLUTIONS LLC
Field: IT methods for management (Electrical engineering)
Classification: CPC G | IPC G

Claim 0:
1. A method comprising:
securely communicating with a virtual data center provided by a healthcare entity, wherein the virtual data center comprises data security rules ensuring that raw carrier claims data downloaded from the virtual data center is downloaded in an encrypted format;
aggregating data from a plurality of different data sources that comprises the virtual data center, wherein the data comprises the raw carrier claims data, and wherein the raw carrier claims data is ingested from the virtual data center in the encrypted format, and wherein the raw carrier claims data comprises all claims processed by a practitioner in a calendar year;
translating the raw carrier claims data by de-encrypting the raw carrier claims data from the encrypted format to a de-encrypted format, wherein the raw carrier claims data must be de-encrypted prior to analysis to calculate cohesion between the practitioner and one or more of a healthcare group or a healthcare clinic over the calendar year;
cleaning the de-encrypted raw carrier claims data by removing at least a portion of the de-encrypted raw carrier claims data to generate cleaned data, wherein the cleaned data comprises only information columns applicable to calculating the cohesion between the practitioner and the one or more of the healthcare group or the healthcare clinic over the calendar year;
generating a modeled version of the cleaned data by generating an intermediary file to reduce an amount of disc storage and Random Access Memory (RAM) required to assess the cleaned data to calculate the cohesion between the practitioner and the one or more of the healthcare group or the healthcare clinic over the calendar year, and wherein generating the intermediary file comprises partitioning the cleaned data based on one or more data metrics included in the cleaned data, wherein the one or more data metrics comprises calendar year and practitioner identifier;
linking the modeled version of the cleaned data to a database platform, wherein the database platform is built on modeled data sources rather than raw data sources, and wherein the database platform is in communication with a user interface that enables viewing of the cleaned data in the intermediary file;
querying the intermediary file on the database platform to identify a target office billing identifier associated with one or more of the healthcare group or the healthcare clinic;
querying the intermediary file on the database platform to identify at least one carrier claim stored within the intermediary file that comprises the target office billing identifier;
querying the intermediary file on the database platform to identify the practitioner associated with the at least one carrier claim that comprises the target office billing identifier;
querying the intermediary file on the database platform to identify a plurality of carrier claims stored within the intermediary file that were billed by the practitioner over the time period; and
calculating a proportion of the plurality of carrier claims that comprise the target office billing identifier to determine cohesion between the practitioner and the one or more of the healthcare group or the healthcare clinic;
wherein the cohesion represents real-world relationships between the practitioner and the one or more of the healthcare group or the healthcare clinic that are given in near real-time based on the raw carrier claims data.