Invention Grant
- Patent Title: System, method, and graphical user interface for identifying medical care providers outside a process-of-care standard
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Application No.: US17039309Application Date: 2020-09-30
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Publication No.: US11244416B2Publication Date: 2022-02-08
- Inventor: Douglas G. Cave , Yuri Alexandrian , John Calvin
- Applicant: Cave Consulting Group, Inc.
- Applicant Address: US CA San Mateo
- Assignee: Cave Consulting Group, Inc.
- Current Assignee: Cave Consulting Group, Inc.
- Current Assignee Address: US CA San Mateo
- Agency: Armstrong Teasdale LLP
- Main IPC: G16H40/20
- IPC: G16H40/20 ; G06Q50/22 ; G06Q10/06

Abstract:
A computer system for identifying medical care providers outside a process-of-care standard for a field of health care is configured to perform steps that include retrieving claim line item information including procedure/service codes, and retrieving definitions for marker code groups associated with each of a set of medical conditions; deriving, for each marker-condition pair, an actual rate of utilization of the marker code group for episodes of the associated medical condition; and assigning a status to each marker-condition pair in response to the actual rate of utilization respectively exceeding or not exceeding a target rate. The steps also include aggregating the statuses across the marker-condition pairs to obtain an overall score, and causing an output to be displayed in a viewable format. The output includes the overall score, each marker-condition pair of the set of medical conditions, and the status for each marker-condition pair of the set of medical conditions.
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Information query