Abstract: Computer implemented systems and methods of health care claim analysis are provided by storing a claim data set in a computer database, including patient information and a DRG assignment based on at least a primary diagnosis code and one or more associated procedure codes. A nominal DRG weight is determined for the claim data set, using a processor in communication with the computer database. The processor looks up an alternate procedure code in the database, and determines an alternate DRG weight for the claim data set by swapping the associated procedure code with the alternate procedure code. A claim score is output to a user interface in communication with the processor, based at least in part on a difference between the nominal and alternate DRG weights.

Abstract: Computer implemented systems and methods of health care claim data analysis are provided by storing a claim data set in a computer database, including patient information and a DRG assignment based on at least primary and secondary diagnosis codes. A nominal DRG weight is determined for the claim data set, using a processor in communication with the computer database. An alternate DRG weight is determined for the claim data set by swapping the primary and secondary diagnosis codes. A claim rating is generated for the claim data set, based at least in part on a difference between the nominal and alternate DRG weights. The claim rating is output to a user interface in communication with the processor.