Systems and methods for a network analyzer tool

Abstract

The present solution provides a new tool to assist clients and prospects in evaluating and optimizing their use of PPO networks. The interactive analysis tool of the present solution allows you to rapidly see the impact of different network configurations based on actual experience measured against a comprehensive bill review database.

1 . (canceled) 
     
     
         2 . A method of establishing a network configuration comprising:
 accessing, by a tool executing on a device, a database storing bill review data for healthcare provider networks;   identifying, by the tool, a first plurality of healthcare provider networks from the database;   identifying, by the tool, a second plurality of healthcare provider networks from the database, the second plurality of healthcare provider networks different from the first plurality of healthcare provider networks;   determining, by the tool, using the bill review data stored in the database, a first efficiency for the first plurality of healthcare provider networks based on a penetration and savings of each of the first plurality of healthcare provider networks;   determining, by the tool, using the bill review data stored in the database, a second efficiency for the second plurality of healthcare provider networks based on a penetration and savings of each of the second plurality of healthcare provider networks;   comparing, by the tool, the first efficiency with the second efficiency; and   selecting, based on the comparison by the tool, the first plurality of healthcare provider networks, the first efficiency greater than the second efficiency.   
     
     
         3 . The method of  claim 2 , further comprising:
 determining, by the tool, the penetration for each of the first plurality of healthcare provider networks based on a total of bill reviewed charges billed to each of the first plurality of health care provider networks divided by a total of bill reviewed charges billed to the first plurality of healthcare provider networks; and   determining, by the tool, the penetration for each of the second plurality of healthcare provider networks based on a total of bill reviewed charges billed to each of the second plurality of health care provider networks divided by a total of bill reviewed charges billed to the second plurality of healthcare provider networks.   
     
     
         4 . The method of  claim 2 , further comprising:
 identifying, by the tool, a reduction for each of the first plurality of healthcare provider networks;   identifying, by the tool, a reduction for each of the second plurality of healthcare provider networks;   determining, by the tool, the first efficiency based on the reduction and the penetration for each of the first plurality of networks; and   determining, by the tool, the second efficiency based on the reduction and the penetration for each of the second plurality of networks.   
     
     
         5 . The method of  claim 2 , further comprising;
 identifying, by the tool, a reduction for each of the first plurality of healthcare provider networks;   determining, by the tool, an efficiency for each of the first plurality of healthcare provider networks as a product of the reduction and the penetration of each of the first plurality of healthcare provider networks; and   determining, by the tool, the first efficiency as a sum of the efficiency for each of the first plurality of healthcare provider networks.   
     
     
         6 . The method of  claim 2 , further comprising:
 identifying, by the tool, a third plurality of healthcare provider networks different from the first plurality of healthcare provider networks and the second plurality of healthcare provider networks;   determining, by the tool, a third efficiency of the third plurality of healthcare provider networks; and   comparing, by the tool, the first efficiency with the third efficiency; and   selecting, by the tool, the first healthcare provider network based on the comparison, the first efficiency greater than the third efficiency.   
     
     
         7 . The method of  claim 2 , wherein at least one of the first plurality of healthcare provider networks is different from at least one of the second plurality of healthcare provider networks. 
     
     
         8 . The method of  claim 2 , further comprising:
 generating, by the tool, a report for the first plurality of healthcare provider networks and the second plurality of healthcare provider networks that includes the first efficiency and the second efficiency.   
     
     
         9 . The method of  claim 2 , further comprising:
 identifying, by the tool, a plurality of service classes associated with the bill review data;   excluding, by the tool, a service class from the plurality of service class to form a subset of service classes; and   determining, by the tool, the first efficiency and the second efficiency based on the subset of service classes.   
     
     
         10 . The method of  claim 2 , further comprising:
 identifying, by the tool, a plurality of service classes associated with the bill review data;   selecting, by the tool, a service class from the plurality of service classes; and   determining, by the tool, the first efficiency and the second efficiency based on the selected service class.   
     
     
         11 . The method of  claim 2 , further comprising:
 receiving, via an interface of the tool, updated bill review data; and   determining, by the tool, the first efficiency and the second efficiency based on the updated bill review data.   
     
     
         12 . The method of  claim 2 , further comprising:
 determining, by the tool, the first efficiency based on a time interval.   
     
     
         13 . The method of  claim 2 , further comprising:
 receiving, via an interface of the tool, a selection of healthcare provider networks to form the first plurality of healthcare care provider networks.   
     
     
         14 . A system for establishing a network configuration comprising:
 an interface of a tool executing on a device configured to access a database storing bill review data for healthcare provider networks;   a network analyzer of the tool configured to:
 identify a first plurality of healthcare provider networks from the database; 
 identify a second plurality of healthcare provider networks from the database, the second plurality of healthcare provider networks different from the first plurality of healthcare provider networks; 
 determine, using the bill review data stored in the database, a first efficiency for the first plurality of healthcare provider networks based on a penetration and savings of each of the first plurality of healthcare provider networks; 
 determine, using the bill review data stored in the database, a second efficiency for the second plurality of healthcare provider networks based on a penetration and savings of each of the second plurality of healthcare provider networks; 
 compare the first efficiency with the second efficiency; and 
 select, based on the comparison, the first plurality of healthcare provider networks, the first efficiency greater than the second efficiency. 
   
     
     
         15 . The system of  claim 14 , wherein the device is further configured to:
 determine the penetration for each of the first plurality of healthcare provider networks based on a total of bill reviewed charges billed to each of the first plurality of health care provider networks divided by a total of bill reviewed charges billed to the first plurality of healthcare provider networks; and   determine the penetration for each of the second plurality of healthcare provider networks based on a total of bill reviewed charges billed to each of the second plurality of health care provider networks divided by a total of bill reviewed charges billed to the second plurality of healthcare provider networks.   
     
     
         16 . The system of  claim 14 , wherein the device is further configured to:
 identify a reduction for each of the first plurality of healthcare provider networks;   identify a reduction for each of the second plurality of healthcare provider networks;   determine the first efficiency based on the reduction and the penetration for each of the first plurality of networks; and   determine the second efficiency based on the reduction and the penetration for each of the second plurality of networks.   
     
     
         17 . The system of  claim 14 , wherein the device is further configured to:
 identify a reduction for each of the first plurality of healthcare provider networks;   determine an efficiency for each of the first plurality of healthcare provider networks as a product of the reduction and the penetration of each of the first plurality of healthcare provider networks; and   determine the first efficiency as a sum of the efficiency for each of the first plurality of healthcare provider networks.   
     
     
         18 . The system of  claim 14 , wherein the device is further configured to:
 identify a third plurality of healthcare provider networks different from the first plurality of healthcare provider networks and the second plurality of healthcare provider networks;   determine a third efficiency of the third plurality of healthcare provider networks; and   compare the first efficiency with the third efficiency; and   select the first healthcare provider network based on the comparison, the first efficiency greater than the third efficiency.   
     
     
         19 . The system of  claim 14 , wherein at least one of the first plurality of healthcare provider networks is different from at least one of the second plurality of healthcare provider networks. 
     
     
         20 . The system of  claim 14 , wherein the device is further configured to:
 generate a report for the first plurality of healthcare provider networks and the second plurality of healthcare provider networks that includes the first efficiency and the second efficiency.   
     
     
         21 . The system of  claim 14 , wherein the device is further configured to:
 identify a plurality of service classes associated with the bill review data;   exclude a service class from the plurality of service class to form a subset of service classes; and   determine the first efficiency and the second efficiency based on the subset of service classes.   
     
     
         22 . The system of  claim 14 , wherein the device is further configured to:
 identify a plurality of service classes associated with the bill review data;   select a service class from the plurality of service classes; and   determine the first efficiency and the second efficiency based on the selected service class.