Abstract: A computerized analysis system for automated anomaly identification is configured to operate at a large scale by retrieving claimline data for a period of time from an input data store. The claimline data includes a plurality of billing codes and prices of the plurality of billing codes. The computerized analysis system is further configured to determine a set of changepoints in the plurality of billing codes in the claimline data and to determine a parameter based on the set of changepoints. The computerized analysis system is also configured to identify a chargemaster increase in response to the parameter exceeding a threshold. In response to identification of the chargemaster increase, the computerized analysis system is configured to publish an alert that indicates occurrence of the chargemaster increase.

Abstract: A computerized analysis system includes a data retrieval module, a spike filter module, a chargemaster analysis module, and an alert module. The data retrieval module is configured to retrieve claimline data for a period of time from an input data store. The claimline data includes billing codes and prices of the billing codes associated with a provider. The spike filter module is configured to flag and filter price spikes in the claimline data. The chargemaster analysis module is configured to determine whether a changepoint exists in the billing codes in the claimline data. The chargemaster analysis module is configured to identify a chargemaster increase for the provider in response to a statistical parameter of changepoints exceeding a threshold. The alert module is configured to, in response to identification of a chargemaster increase, publish an alert that a chargemaster increase has occurred for the provider.

Abstract: An analysis system includes a data retrieval module that retrieves claimline data for a period of time. The claimline data includes multiple billing codes and corresponding prices associated with a provider. An analysis module receives the claimline data from the data retrieval module, determines whether a changepoint exists in the billing codes in the claimline data, determines a statistical parameter of changepoints per day during the period of time, and identifies a chargemaster increase for the provider in response to the statistical parameter of changepoints exceeding a threshold. An alert module, in response to identification of a chargemaster increase, publishes an alert that a chargemaster increase has occurred. The alert includes the provider's identification, a chargemaster increase date, a claimline number, a changepoint number, the billing code identification, or a price of the billing code at the changepoint. The alert transforms a user interface displayed to a user.

Abstract: A computerized processing system includes a communication interface configured to receive, from a user device, inputs defining rules for calculating reimbursements for healthcare services and receive historical claims data. The historical claims data includes a plurality of claims submitted to an insurance provider over a previous predetermined period. A contract development module is configured to generate a contract based on the inputs; match the claims in the historical claims data to respective ones of the rules in the contract as defined by the inputs; calculate costs associated with the contract using the claims in the historical claims data and the rules; and output, for display via a user interface, a report including the calculated costs associated with the contract.