20090125348 | METHODS FOR GENERATING HEALTHCARE PROVIDER QUALITY AND COST RATING DATA - A computer-implemented method for generating healthcare provider quality rating data from healthcare claim records representing services provided by a plurality of healthcare providers (such as physicians or hospitals) to one or more patients includes grouping the claim records into one or more claim groups, each representing services provided to a patient by one or more providers; assigning each claim group to a responsible provider; assessing the claim records in each claim group using guidelines for the particular disease or condition and generating a compliance score for the claim group, wherein the compliance score indicates the extent to which the claim records in the claim group match the guidelines; and generating provider quality rating data for each provider using the normalized aggregate compliance score. The provider quality rating data may include one or more performance categories or graphic symbols that indicate the provider's quality of treatment in comparison to an average value. Provider volume data may also be generated. | 05-14-2009 |