A Data Science Central Community
We are putting together our Spring Health Care Centric Meeting. http://MinneAnalytics.org
Part of the day will be focused on "The Life Cycle of a Health Care Claim". The balance of the program will be various topics on "Health Care Analytics". These sessions will include information useful to anyone that does analytics in any industry.
Location: CPC in Edina, MN at Highway 100 & W. 70th St.
Date and Time: March 31, 2011. All Day event but you will be able to come and go as you please during the day.
Main room capacity is 300, plus we will have a couple of smaller rooms at that will accommodate another 60 to 80 each for our breakouts.
Most of us see claims after they end up in a data warehouse. Few of us completely understand everything that happens to that claim before we see it.
So our early idea is this: We will start with a claims inception when a Provider, Facility, or Pharmacy, provides a service to it's birth as it enters the payment system. Continuing on into childhood as the claim enters the clearing house and on to the payer. Exploring the difficult adolescence as it is examined for Fraud & Abuse, faces rejection, and deals with adjustments. Reaching adulthood with reimbursement completed the claim takes on another life as it enters many data warehouses where it may get repeatedly poked. It pushes on as it is analyzed along with others to determine possible patient engagement where it may result in a return to services for the patient and the whole process starts over again. What should Analytics people know about what happens and what we don't know.
Currently we have:
As we build out this program we are looking to fill in a few things: On the early side Pharmacy claim information, ETL processes that occur after reimbursement that alter character of claims, and possibly DRG, APG & other grouping methods. Also, the future of Clinical messaging and the impact of CDHP on patient behavior. More to come.
What would you like to take away from this? Can you contribute? We would appreciate input from our members. Contact Dan Atkins.