Patent ID: 8700433
Filing Date: 2014-04-15
Classification: G06Q,G16H

Abstract:
1. A computer-implemented process for profiling medical claims including the steps of: (a) reading a first patient's medical claim data, input as at least one of a plurality of data records, into a computer memory; (b) validating each of the at least one of a plurality of data records for at least one of a diagnosis code and a treatment code using a computer processor; (c) reading at least one pre-defined relation between the at least one of a diagnosis code and a treatment code in the validated at least one of a plurality of data records and pre-defined medical episodes using the computer processor; and (d) grouping the validated at least one of a plurality of data records to at least one of a plurality of episode treatment groups, each of the at least one of a plurality of episode treatment groups further comprising one anchor record and n data records linked thereto using the computer processor, the n data records being selected from the group consisting of ancillary records, facility records and prescription drug records, where n is an integer greater than or equal to 0, and having a predefined time window during which the n data records may group to the one anchor record.