| 摘要 |
A computerized system and method for measuring and analyzing provider utilization is disclosed. In an example embodiment, a Provider Utilization Management Software Application comprises a data selection component and a presentation model that illustrates how a provider's claim data submitted to a health benefits company compares to providers in the same network, geographic region, or other provider grouping (e.g., by state, zip code, MSA, provider specialty type, or in-plan status). This utilization data may be used to identify problem providers that have high, low, or unusual utilization patterns. Various measures may be calculated and analyzed. Results of the analysis may be presented in various reports. Once problem providers are identified, they may be monitored. In some instances, one or more corrective actions may be taken. |
