US 11,756,002 B2
Identification of relationships between healthcare practitioners and healthcare clinics based on billed claims
Robert Richards, Salt Lake City, UT (US); and David Muhlestein, Salt Lake City, UT (US)
Assigned to Milliman Solutions LLC, Seattle, WA (US)
Filed by Milliman Solutions LLC, Seattle, WA (US)
Filed on Mar. 12, 2020, as Appl. No. 16/816,602.
Claims priority of provisional application 62/939,349, filed on Nov. 22, 2019.
Prior Publication US 2021/0158942 A1, May 27, 2021
This patent is subject to a terminal disclaimer.
Int. Cl. G06F 16/90 (2019.01); G06F 16/28 (2019.01); G16H 40/20 (2018.01); G16H 10/60 (2018.01); G06Q 40/12 (2023.01); G06Q 10/105 (2023.01); G06F 16/24 (2019.01); G16H 70/20 (2018.01); G06Q 10/10 (2023.01); G06Q 30/018 (2023.01); G16H 50/70 (2018.01); G06Q 10/0639 (2023.01); G06Q 50/26 (2012.01); G16H 40/00 (2018.01); G06F 21/60 (2013.01); G06F 21/62 (2013.01); G06Q 30/04 (2012.01); G06Q 40/08 (2012.01)
CPC G06Q 10/105 (2013.01) [G06F 16/24 (2019.01); G06F 16/284 (2019.01); G06F 16/288 (2019.01); G06F 16/90 (2019.01); G06F 21/602 (2013.01); G06F 21/6245 (2013.01); G06Q 10/06398 (2013.01); G06Q 10/10 (2013.01); G06Q 30/0185 (2013.01); G06Q 30/04 (2013.01); G06Q 40/12 (2013.12); G06Q 50/265 (2013.01); G16H 10/60 (2018.01); G16H 40/00 (2018.01); G16H 40/20 (2018.01); G16H 50/70 (2018.01); G16H 70/20 (2018.01); G06Q 40/08 (2013.01)] 20 Claims
OG exemplary drawing
 
1. A method comprising:
aggregating data from a plurality of different data sources, wherein the aggregated data comprises raw data ingested from an external data source in an encrypted format, and wherein the raw data comprises raw carrier claims data;
translating the raw data by de-encrypting the raw data from the encrypted format to a de-encrypted format;
cleaning the de-encrypted raw data by removing at least a portion of the de-encrypted raw data to generate clean data;
generating a modeled version of the clean data by generating an intermediary file within a database, wherein the modeled version is stored in a single table stored on the database, and wherein the intermediary file comprises information for determining whether a practitioner is associated with a clinic based on carrier claims processed by the practitioner;
querying the database to identify the clinic associated with the practitioner by assessing the carrier claims processed by the practitioner over a time period, wherein the carrier claims are stored in the single table comprising the modeled version of the clean data;
calculating a quantity of the carrier claims that identify the clinic to determine a quantity of clinic claims;
calculating a total quantity of carrier claims processed by the practitioner over the time period; and
determining whether the practitioner is associated with the clinic based on the quantity of clinic claims and the total quantity of carrier claims;
wherein determining whether the practitioner is associated with the clinic reflects real-world associations between the practitioner and the clinic given in real-time based on carrier claims processed by the practitioner.