Patent ID: 8069080

Claim:
A computer-implemented method for generating healthcare provider quality rating data, comprising: providing data storage for storing medical claim data; providing at least one computer processor programmed for receiving a plurality of claim records representing services provided by a plurality of healthcare providers to one or more patients; grouping the claim records into at least one claim group, each claim group including claim records representing care provided by one or more providers to a patient; assigning each claim group to a responsible provider; assessing the claim records in each claim group using expected treatment guidelines for the particular disease or condition associated with the claim group and generating a compliance score for the claim group, wherein the compliance score indicates the extent to which the claim records in the claim group match the guidelines; aggregating the compliance score for each claim group assigned to each provider to generate a raw aggregate compliance score for each provider; normalizing the provider's raw aggregate compliance score to a defined scale to generate a normalized aggregate compliance score for each provider; and generating provider quality rating data for each provider using the normalized aggregate compliance score.