Patent ID: 7774252

Claim:
A computer-implemented process for processing medical claims comprising a computer performing the following: (a) reading 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; (c) reading at least one pre-defined relationship 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 episode treatment categories; (d) grouping the validated at least one of a plurality of data records to an episode treatment category based upon the pre-defined relationship, each episode treatment category having a dynamic time window defining a time period during which validated at least one of plurality of data records may be grouped to an episode treatment category; and (e) classifying the patient data records into at least one of a plurality of episode treatment groups, each of the plurality of episode treatment groups being defined by an episode treatment category.