US Patent No: 8,069,080 - Analytics, PDF, Full Text and PAIR Access

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Methods for generating healthcare provider quality and cost rating data

ALSO PUBLISHED AS: 20090125348

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Abstract

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A method for generating healthcare provider quality rating data includes grouping claim records into one or more claim groups, assigning each claim group to a responsible provider, assessing the claim records in each claim group using guidelines for the particular disease or condition, 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, and generating normalized provider quality rating data. A method for generating healthcare provider cost rating data includes grouping claim records into one or more claim groups, assigning each claim group to a responsible provider, calculating the total cost of each claim group, aggregating the total cost for each claim group, and comparing the total aggregate cost of each claim group assigned to each provider to an expected cost value.

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Patent Owner(s)

Patent OwnerAddressTotal Patents
INGENIX, INC.EDEN PRAIRIE, MN7
OPTUMINSIGHT, INC.MENLO, CA38

International Classification(s)

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Inventor(s)

Inventor Name Address # of filed Patents Total Citations
Rastogi, Amita - 4 2

Cited Art Landscape

Patent Info (Count) # Cites Year
 
FAIR ISAAC CORPORATION (1)
* 2003/0158,751 Fraud and abuse detection and entity profiling in hierarchical coded payment systems 20 2002
 
OPTUMINSIGHT, INC. (1)
2007/0156,455 System and Method for Providing a Consumer Healthcare Guide 6 2006
 
QUALITY HEALTHCARE INTERMEDIARY, LLC (1)
* 2004/0111,291 Method of optimizing healthcare services consumption 35 2002
 
SYMMETRY HEALTH DATA SYSTEMS (1)
5,835,897 Computer-implemented method for profiling medical claims 159 1995
 
UNITED HEALTHCARE CORPORATION (1)
5,544,044 Method for evaluation of health care quality 122 1991
* Cited By Examiner

Patent Citation Ranking

Forward Cite Landscape

Patent Info (Count) # Cites Year
 
ALLIANCE ENTERPRISES, INC. (1)
* 8,725,555 Vendor performance management system and method for determining a vendor's contribution value and vendor services score 0 2012
* Cited By Examiner

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