Unlocking Claims Value with Claim Insight

Healthcare administrative data, such as claims, could be an invaluable source for data analysis.

Claims contain a wealth of information, going beyond financial data. For their claims to be paid, providers must submit sufficient supporting documentation along with their charges. At the very minimum, this documentation must include diagnosis codes and procedure codes.

Claims also contain patient demographics data, such as age, gender, and address.

Claims can also include various other useful bits and pieces, such as drug and equipment codes, hospitalization information, and so on.

Claims data can be used for many purposes and in different contexts.

Payers, of course, can use claims data to gain numerous insights into how their money is being spent.

Researchers can rely on claims to derive many population health metrics.

Providers could use claims data to learn about a patient’s medical history (assuming claims from other providers are somehow available).

Claims data can be used for tracking adherence to a treatment protocol, e.g. if a medicine prescription has been filled/re-filled.

Because of the HIPAA’s requirement to use X12 EDI for data transmission, claims data format is very well standardized, which makes collecting data from multiple sources easy (privacy requirements should still be taken into account).

These are some of the reasons why we developed our Claim Insight platform that aims to simplify all aspects of dealing with healthcare claims – from IT operations and data ingest to analytics and data/payment integrity.

Claim Insight works directly with claims in X12 EDI format. To get started, point Claim Insight to a location (or multiple locations) containing EDI files, press the “Load” button, and the product will begin ingesting data.

Claim Insight’s loading process is extremely fast; it has been fine-tuned to work with many millions of claims. It can efficiently deal with thousands of files containing just a handful of EDI transactions/claims or with multi-gigabyte files with many claims batched together.

Claim Insight can also scan pre-defined locations (file shares, directories, SFTP, various flavors of blob storage) to detect and load newly arrived files automatically.

Claim Insight generates many analytical and statistical metrics on the fly as the data is being loaded. The metrics provide breakdowns by top billed/paid procedures, procedure categories, providers, provider taxonomies, and so on. There is also time-based analytics that shows trends and identifies outliers.

In short, Claim Insight provides all the functionality that one would need to work with healthcare claims data.

From an IT architecture standpoint, Claim Insight performs functions of a “data lake,” ETL, operational data store, and data warehouse for claims all in one bundle.

Claim Insight could be an invaluable tool for any analyst or investigator. It comes with a modern UI, powerful search, and sophisticated analytics out of the box. It is extremely easy to get started with. Claim Insight requires minimal configuration or customization (besides configuring when and where source claims data).

You can request access to Claim Insight by filling out this form.

In future blog posts, we will cover various Claim Insight features and related topics.