Abstract: Identifying relationships between healthcare practitioners and healthcare facilities based on billed claims. A method includes assessing facility claims billed by a facility over a time period to identify a practitioner that performed a procedure at the facility within the time period and assessing carrier claims billed by the practitioner over the time period to identify all facilities in which the practitioner performed a procedure within the time period. The method includes calculating a total quantity of the facility claims billed over the time period that indicate a procedure was performed at the facility and a total quantity of the carrier claims billed by the practitioner over the time period that indicate the practitioner performed a procedure.

Abstract: Identifying and quantifying a professional relationship between a practitioner and a clinic. A method includes identifying a clinic associated with a practitioner by assessing claims processed by the practitioner, identifying the clinic that are processed by the practitioner, and calculating a total quantity of claims processed by the practitioner. The method includes quantifying a relationship between the practitioner and the clinic based on the quantity of clinic claims and the total quantity of claims.

Abstract: Identifying ownership of a healthcare clinic based on enrollment information. A method includes identifying a plurality of practitioners associated with a clinic and calculating a proportion of the plurality of practitioners that are enrolled under a healthcare group based on enrollment information stored in an enrollment database. The method includes determining whether the proportion satisfies a threshold proportion of practitioners enrolled under the healthcare group and imputing a group ID associated with the healthcare group to the clinic if the proportion satisfies the threshold proportion.

Abstract: Systems, methods, and devices for identifying and quantifying an employment relationship between a practitioner and a facility. A method includes identifying carrier claims processed by a practitioner for procedures performed through a facility and matching the carrier claims to the facility to generate matched claims. The method includes calculating a percentage of outpatient claims based on a percentage of office claims performed by the practitioner that did not occur at the facility. The method includes calculating a level of confidence that the practitioner is employed by the facility based on the matched claims and the percentage of outpatient claims.

Abstract: Determining cohesion of healthcare groups and clinics based on billed claims. A method includes determining a target office billing identifier associated with one or more of a healthcare group or a healthcare clinic and determining a practitioner billing a carrier claim comprising the target office billing identifier. The method includes identifying a plurality of carrier claims billed by the practitioner over a time period. The method includes calculating a proportion of the plurality of carrier claims that comprise the target office billing identifier.

Abstract: Matching healthcare groups and healthcare systems based on billed claims and calculating capture of billed procedures for healthcare groups and systems. A method includes identifying one or more office practitioners billing carrier claims comprising a certain office billing identifier and identifying one or more procedure practitioners associated with facility claims for procedures performed under a certain procedure billing identifier. The method includes identifying a common practitioner billing carrier claims comprising the certain office billing identifier and associated with facility claims for procedures performed under the certain procedure billing identifier. The method includes generating an office-procedure pair by matching the certain office billing identifier with the certain procedure billing identifier based on an existence of the common practitioner.

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.

Abstract: Identifying and quantifying referral patterns between healthcare entities based on billed claims. A method includes determining a plurality of billed claims and identifying one or more unique performing healthcare entities included in at least one of the plurality of billed claims. The method includes identifying one or more unique referring identifiers included in at least one of the plurality of billed claims. The method includes, for at least one of the one or more unique performing healthcare entities, calculating a proportion of referrals coming from each of the one or more unique referring identifiers over the plurality of billed claims.

Abstract: Determining cohesion of healthcare systems and facilities based on billed claims. A method includes determining a target procedure billing identifier associated with one or more of a healthcare system or a healthcare facility and identifying a practitioner associated with a facility claim comprising the target procedure billing identifier. The method includes identifying a plurality of facility claims billed by the practitioner over a time period and calculating a proportion of the plurality of facility claims that comprise the target procedure billing identifier.