Patent ID: 8447671
Filing Date: 2013-05-21
Classification: G16H

Abstract:
1. A method of evaluating medical service providers and directing claimants using a computer and a database comprising the steps of; storing a provider list on the database including a plurality of medical service providers; developing at least one provider profile including general provider information for each of the medical service providers on the provider list; storing a claim list on the database including all claimants and claims made by claimants with all of the medical service providers on the provider list; developing claim profiles including general provider information and general claimant information for each of the claims made by each of the claimants; executing a profile assignment step in the computer to assign claim profiles to provider profiles based on general provider information; executing a provider score step in the computer using predictive analytics to generate a provider score for each of the provider profiles based on the claim profiles in response to executing said profile assignment step; executing a sorting step in the computer to rank order the plurality of medical service providers by the provider scores in response to executing said provider score step; executing a first provider group step in the computer to programmatically compare the provider scores to a fixed rank value and group the medical service providers having provider scores above the fixed rank value into a first provider group; executing a second provider group step in the computer to programmatically compare the provider scores to the fixed rank value and group the medical service providers having provider scores below the fixed rank value into a second provider group; executing a control group step in the computer to programmatically group claimants making claims to medical service providers in the first provider group into a control group; executing a decision group step in the computer to programmatically group claimants making claims to medical service providers in the second provider group into a decision group; executing a redirect group step in the computer to programmatically transform at least some of the claimants in the decision group into claimants in a redirect group in response to processing general claimant information; and executing a redirect decision step in the computer to programmatically direct claimants in the redirect group from medical service providers in the second provider group to medical service providers having provider scores at a first pre-determined level relative to a fixed redirect value in the first provider group in response to executing said redirect group step.