Matching healthcare claim data for identifying and quantifying relationships between healthcare entities

Abstract

Matching carrier claims to facilities based on billed claims data in a healthcare system. A method includes identifying a carrier claim processed by a practitioner and matching the carrier claim to a facility to generate a matched claim based on a claims factor. The method is such that the claims factor comprises one or more of a patient identifier, a date of service for a procedure billed on the carrier claim, a practitioner identifier associated with the practitioner, a facility identifier for an inpatient facility associated with the carrier claim if the carrier claim occurred during a hospitalization at the inpatient facility, a most common facility associated with the practitioner.

What is claimed is: 
     
         1 . A method comprising:
 identifying a carrier claim processed by a practitioner; and   matching the carrier claim to a facility to generate a matched claim based on a claims factor;   wherein the claims factor comprises one or more of:
 a patient identifier; 
 a date of service for a procedure billed on the carrier claim; 
 a practitioner identifier associated with the practitioner; 
 a facility identifier for an inpatient facility associated with the carrier claim if the carrier claim occurred during a hospitalization at the inpatient facility; or 
 a most common facility associated with the practitioner. 
   
     
     
         2 . The method of  claim 1 , wherein identifying the carrier claim comprises identifying a plurality of carrier claims processed by the practitioner over a time period, and wherein the method further comprises identifying a plurality of facility claims processed by the facility over the time period. 
     
     
         3 . The method of  claim 2 , wherein matching the carrier claim to the facility comprises matching at least one of the plurality of carrier claims to at least one of the plurality of facility claims based on the claims factor to generate one or more matched claims. 
     
     
         4 . The method of  claim 3 , further comprising:
 calculating a percentage of outpatient claims based on a percentage of office claims performed by the practitioner that did not occur at the facility by collapsing the one or more matched claims on a practitioner identifier associated with the practitioner; and   calculating a level of confidence the practitioner is employed by the facility based on the one or more matched claims and the percentage of outpatient claims.   
     
     
         5 . The method of  claim 4 , further comprising:
 collapsing the one or more matched claims to a group level, wherein the facility is a healthcare facility associated with a healthcare group; and   calculating a percentage of employment by calculating a percentage of practitioners associated with the healthcare group that are employed by a facility associated with the healthcare group.   
     
     
         6 . The method of  claim 1 , wherein matching the carrier claim to the facility comprises matching based on:
 in a first matching iteration, a patient identifier for a patient that received a procedure from the practitioner, a date of service for the procedure performed, and a procedure code for the procedure;   in a second matching iteration, the patient identifier, the date of service, and an practitioner ID (National Provider Identifier) associated with the practitioner;   in a third matching iteration, an inpatient facility associated with a carrier claim if the carrier claim occurred during a hospitalization at the inpatient facility;   in a fourth matching iteration, the date of service and a most common facility associated with the practitioner; and   in a fifth matching iteration, the most common facility associated with the practitioner as determined based on an clinic ID (National Provider Identifier) in a carrier claim.   
     
     
         7 . The method of  claim 6 , wherein matching the carrier claim to the facility comprises matching based on:
 in a sixth matching iteration, the date of service and the most common facility associated with the practitioner;   in a seventh matching iteration, the date of service and recent most common facility associated with the practitioner based on claims processed by the practitioner in a recent time period;   in an eighth matching iteration, the date of service and the most common facility associated with the practitioner;   in a ninth matching iteration, a most common facility associated with the practitioner using previously joined facilities; and   in a tenth matching iteration, a facility most closely link to the clinic ID based on the carrier claim.   
     
     
         8 . The method of  claim 7 , wherein matching the carrier claim to the facility comprises matching a plurality of carrier claims billed by the practitioner over a time period to one or more facilities. 
     
     
         9 . The method of  claim 8 , wherein:
 matching the plurality of carrier claims to the one or more facilities comprises performing a plurality of independent matching iterations in succession, wherein the plurality of independent matching iterations comprises the first matching iteration, the second matching iteration, the third matching iteration, the fourth matching iteration, the fifth matching iteration, the sixth matching iteration, the seventh matching iteration, the eight matching iteration, the ninth matching iteration, and the tenth matching iteration; and   for each matching iteration of the plurality of independent matching iterations, matching previously unmatched carrier claims of the plurality of carrier claims to a facility of the one or more facilities based on one or more claims factors in an instant matching iteration.   
     
     
         10 . The method of  claim 1 , wherein the claims factor comprises each of:
 the patient identifier, wherein the patient identifier is associated with a patient that received a procedure from the practitioner;   the date of service for the procedure billed on the carrier claim;   a procedure code for the procedure billed on the carrier claim;   the practitioner identifier associated with the practitioner, wherein the practitioner identifier is an individual National Provider Identifier;   the facility identifier for the inpatient facility if the procedure billed on the carrier claim occurred during a hospitalization at the inpatient facility, wherein the facility identifier is a CMS Certification Number;   the most common facility associated with the practitioner based on a plurality of carrier claims billed by the practitioner;   a clinic identifier associated with the facility, wherein the clinic identifier is an organization National Provider Identifier; and   a facility most commonly linked to the clinic identifier based on the plurality of carrier claims billed by the practitioner.   
     
     
         11 . A system comprising one or more processors for executing instructions stored in non-transitory computer readable storage media, the instructions comprising:
 identifying a carrier claim processed by a practitioner; and   matching the carrier claim to a facility to generate a matched claim based on a claims factor;   wherein the claims factor comprises one or more of:
 a patient identifier; 
 a date of service for a procedure billed on the carrier claim; 
 a practitioner identifier associated with the practitioner; 
 a facility identifier for an inpatient facility associated with the carrier claim if the carrier claim occurred during a hospitalization at the inpatient facility; or 
 a most common facility associated with the practitioner. 
   
     
     
         12 . The system of  claim 11 , wherein the instructions are such that identifying the carrier claim comprises identifying a plurality of carrier claims processed by the practitioner over a time period, and wherein the method further comprises identifying a plurality of facility claims processed by the facility over the time period. 
     
     
         13 . The system of  claim 12 , wherein the instructions are such that matching the carrier claim to the facility comprises matching at least one of the plurality of carrier claims to at least one of the plurality of facility claims based on the claims factor to generate one or more matched claims. 
     
     
         14 . The system of  claim 13 , wherein the instructions further comprise:
 calculating a percentage of outpatient claims based on a percentage of office claims performed by the practitioner that did not occur at the facility by collapsing the one or more matched claims on a practitioner identifier associated with the practitioner; and   calculating a level of confidence the practitioner is employed by the facility based on the one or more matched claims and the percentage of outpatient claims.   
     
     
         15 . The system of  claim 14 , wherein the instructions further comprise:
 collapsing the one or more matched claims to a group level, wherein the facility is a healthcare facility associated with a healthcare group; and   calculating a percentage of employment by calculating a percentage of practitioners associated with the healthcare group that are employed by a facility associated with the healthcare group.   
     
     
         16 . The system of  claim 11 , wherein the instructions are such that matching the carrier claim to the facility comprises matching based on:
 in a first matching iteration, a patient identifier for a patient that received a procedure from the practitioner, a date of service for the procedure performed, and a procedure code for the procedure;   in a second matching iteration, the patient identifier, the date of service, and an practitioner ID (National Provider Identifier) associated with the practitioner;   in a third matching iteration, an inpatient facility associated with a carrier claim if the carrier claim occurred during a hospitalization at the inpatient facility;   in a fourth matching iteration, the date of service and a most common facility associated with the practitioner; and   in a fifth matching iteration, the most common facility associated with the practitioner as determined based on an clinic ID (National Provider Identifier) in a carrier claim.   
     
     
         17 . The system of  claim 16 , wherein the instructions are such that matching the carrier claim to the facility comprises matching based on:
 in a sixth matching iteration, the date of service and the most common facility associated with the practitioner;   in a seventh matching iteration, the date of service and recent most common facility associated with the practitioner based on claims processed by the practitioner in a recent time period;   in an eighth matching iteration, the date of service and the most common facility associated with the practitioner;   in a ninth matching iteration, a most common facility associated with the practitioner using previously joined facilities; and   in a tenth matching iteration, a facility most closely link to the clinic ID based on the carrier claim.   
     
     
         18 . The system of  claim 17 , wherein the instructions are such that matching the carrier claim to the facility comprises matching a plurality of carrier claims billed by the practitioner over a time period to one or more facilities. 
     
     
         19 . The system of  claim 18 , wherein the instructions are such that:
 matching the plurality of carrier claims to the one or more facilities comprises performing a plurality of independent matching iterations in succession, wherein the plurality of independent matching iterations comprises the first matching iteration, the second matching iteration, the third matching iteration, the fourth matching iteration, the fifth matching iteration, the sixth matching iteration, the seventh matching iteration, the eight matching iteration, the ninth matching iteration, and the tenth matching iteration; and   for each matching iteration of the plurality of independent matching iterations, matching previously unmatched carrier claims of the plurality of carrier claims to a facility of the one or more facilities based on one or more claims factors in an instant matching iteration.   
     
     
         20 . The system of  claim 11 , wherein the claims factor comprises each of:
 the patient identifier, wherein the patient identifier is associated with a patient that received a procedure from the practitioner;   the date of service for the procedure billed on the carrier claim;   a procedure code for the procedure billed on the carrier claim;   the practitioner identifier associated with the practitioner, wherein the practitioner identifier is an individual National Provider Identifier;   the facility identifier for the inpatient facility if the procedure billed on the carrier claim occurred during a hospitalization at the inpatient facility, wherein the facility identifier is a CMS Certification Number;   the most common facility associated with the practitioner based on a plurality of carrier claims billed by the practitioner;   a clinic identifier associated with the facility, wherein the clinic identifier is an organization National Provider Identifier; and   a facility most commonly linked to the clinic identifier based on the plurality of carrier claims billed by the practitioner.   
     
     
         21 . Non-transitory computer readable storage media storing instructions for execution by one or more processors, the instructions comprising:
 identifying a carrier claim processed by a practitioner; and   matching the carrier claim to a facility to generate a matched claim based on a claims factor;   wherein the claims factor comprises one or more of:
 a patient identifier; 
 a date of service for a procedure billed on the carrier claim; 
 a practitioner identifier associated with the practitioner; 
 a facility identifier for an inpatient facility associated with the carrier claim if the carrier claim occurred during a hospitalization at the inpatient facility; or 
 a most common facility associated with the practitioner. 
   
     
     
         22 . The non-transitory computer readable storage media of  claim 21 , wherein the instructions are such that identifying the carrier claim comprises identifying a plurality of carrier claims processed by the practitioner over a time period, and wherein the method further comprises identifying a plurality of facility claims processed by the facility over the time period. 
     
     
         23 . The non-transitory computer readable storage media of  claim 22 , wherein the instructions are such that matching the carrier claim to the facility comprises matching at least one of the plurality of carrier claims to at least one of the plurality of facility claims based on the claims factor to generate one or more matched claims. 
     
     
         24 . The non-transitory computer readable storage media of  claim 23 , wherein the instructions further comprise:
 calculating a percentage of outpatient claims based on a percentage of office claims performed by the practitioner that did not occur at the facility by collapsing the one or more matched claims on a practitioner identifier associated with the practitioner; and   calculating a level of confidence the practitioner is employed by the facility based on the one or more matched claims and the percentage of outpatient claims.   
     
     
         25 . The non-transitory computer readable storage media of  claim 24 , wherein the instructions further comprise:
 collapsing the one or more matched claims to a group level, wherein the facility is a healthcare facility associated with a healthcare group; and   calculating a percentage of employment by calculating a percentage of practitioners associated with the healthcare group that are employed by a facility associated with the healthcare group.   
     
     
         26 . The non-transitory computer readable storage media of  claim 21 , wherein the instructions are such that matching the carrier claim to the facility comprises matching based on:
 in a first matching iteration, a patient identifier for a patient that received a procedure from the practitioner, a date of service for the procedure performed, and a procedure code for the procedure;   in a second matching iteration, the patient identifier, the date of service, and an practitioner ID (National Provider Identifier) associated with the practitioner;   in a third matching iteration, an inpatient facility associated with a carrier claim if the carrier claim occurred during a hospitalization at the inpatient facility;   in a fourth matching iteration, the date of service and a most common facility associated with the practitioner; and   in a fifth matching iteration, the most common facility associated with the practitioner as determined based on an clinic ID (National Provider Identifier) in a carrier claim.   
     
     
         27 . The non-transitory computer readable storage media of  claim 26 , wherein the instructions are such that matching the carrier claim to the facility comprises matching based on:
 in a sixth matching iteration, the date of service and the most common facility associated with the practitioner;   in a seventh matching iteration, the date of service and recent most common facility associated with the practitioner based on claims processed by the practitioner in a recent time period;   in an eighth matching iteration, the date of service and the most common facility associated with the practitioner;   in a ninth matching iteration, a most common facility associated with the practitioner using previously joined facilities; and   in a tenth matching iteration, a facility most closely link to the clinic ID based on the carrier claim.   
     
     
         28 . The non-transitory computer readable storage media of  claim 27 , wherein the instructions are such that matching the carrier claim to the facility comprises matching a plurality of carrier claims billed by the practitioner over a time period to one or more facilities. 
     
     
         29 . The non-transitory computer readable storage media of  claim 28 , wherein the instructions are such that:
 matching the plurality of carrier claims to the one or more facilities comprises performing a plurality of independent matching iterations in succession, wherein the plurality of independent matching iterations comprises the first matching iteration, the second matching iteration, the third matching iteration, the fourth matching iteration, the fifth matching iteration, the sixth matching iteration, the seventh matching iteration, the eight matching iteration, the ninth matching iteration, and the tenth matching iteration; and   for each matching iteration of the plurality of independent matching iterations, matching previously unmatched carrier claims of the plurality of carrier claims to a facility of the one or more facilities based on one or more claims factors in an instant matching iteration.   
     
     
         30 . The non-transitory computer readable storage media of  claim 21 , wherein the claims factor comprises each of:
 the patient identifier, wherein the patient identifier is associated with a patient that received a procedure from the practitioner;   the date of service for the procedure billed on the carrier claim;   a procedure code for the procedure billed on the carrier claim;   the practitioner identifier associated with the practitioner, wherein the practitioner identifier is an individual National Provider Identifier;   the facility identifier for the inpatient facility if the procedure billed on the carrier claim occurred during a hospitalization at the inpatient facility, wherein the facility identifier is a CMS Certification Number;   the most common facility associated with the practitioner based on a plurality of carrier claims billed by the practitioner;   a clinic identifier associated with the facility, wherein the clinic identifier is an organization National Provider Identifier; and   a facility most commonly linked to the clinic identifier based on the plurality of carrier claims billed by the practitioner.