Computer-implemented systems and methods for multi-level data grouping and generation of a hierarchical data display from uniform claims data

1 . A computer-based system comprising one or more processors and memory, the computer-based system configured to:

store, by the one or more processors and in the memory, a plurality of individual claim records, wherein each individual claim record of the plurality of individual claim records has a non-hierarchical data structure;

generate, by the one or more processors, a plurality of single-level episode data objects, each of the plurality of single-level episode data objects relating to an episode-specific subset of individual claim records of the plurality of individual claim records, wherein each single-level episode data object of the plurality of single-level episode data objects identifies a first parent episode record of the episode-specific subset of individual claim records, and wherein the first parent episode record identifies one or more characteristics of a corresponding single-level episode data object;

retrieve, by the one or more processors and based at least in part on data stored within the plurality of single-level episode data objects, a reference table stored in the memory, wherein the reference table comprises a plurality of data entries identifying one or more characteristics of single-level episode data objects that are eligible for supporting one or more sub-episodes;

identify, by the one or more processors and from the plurality of single-level episode data objects and based at least in part on the reference table, an eligible subset of the plurality of single-level episode data objects eligible for supporting the one or more sub-episodes;

retrieve, by the one or more processors and from the memory, one or more sub-episode eligibility criteria comprising sub-episode eligibility criteria reference data tables;

for a first single-level episode data object of the eligible subset, sequentially generate, by the one or more processors, one or more entries of a sub-episode eligibility listing in the memory based at least in part on characteristics identified for the first single-level episode data object, wherein each of the one or more entries has a corresponding individual claim record associated with the first single-level episode data object;

identify, by the one or more processors and from the one or more entries, one or more sub-episode records satisfying the one or more sub-episode eligibility criteria;

generate, by the one or more processors, one or more first sub-episode data objects that identify at least one of the one or more sub-episode records;

update, by the one or more processors, the one or more first sub-episode data objects based at least in part on the one or more characteristics of the first single-level episode data object;

transform, by the one or more processors, the first single-level episode data object into a multi-level hierarchical data object having metadata tags providing a hierarchical data structure comprising one or more sub-episode identifiers corresponding with the one or more first sub-episode data objects; and

store, by the one or more processors and into the memory, the multi-level hierarchical data object.

2 . The computer-based system of claim 1 , wherein the computer-based system is further configured to:

identify, by the one or more processors and from the one or more entries, one or more sub-episode anchor records satisfying the one or more sub-episode eligibility criteria;

identify, by the one or more processors and from the plurality of individual claim records, one or more sub-episode ancillary records associated with the one or more sub-episode anchor records;

generate, by the one or more processors, one or more second sub-episode data objects that each identifies one of the one or more sub-episode anchor records and the one or more sub-episode ancillary records; and

cause, by the one or more processors and based at least in part on the multi-level hierarchical data object, display of a multi-level view of at least one of the one or more sub-episode anchor records or the one or more sub-episode ancillary records identified by the one or more second sub-episode data objects;

wherein each single-level episode data object of the plurality of single-level episode data objects identifies (a) a parent episode date range indicating an episode start date and an episode end date, (b) a first parent episode anchor record of a plurality of parent episode anchor records that corresponds to the episode-specific subset of individual claim records, wherein each parent episode anchor record of the plurality of parent episode anchor records identifies an episode type of the corresponding single-level episode data object.

3 . The computer-based system of claim 2 , wherein (a) the first parent episode anchor record is associated with the first single-level episode data object and comprises data identifying a plurality of diagnosis codes associated with the first parent episode anchor record, (b) the sub-episode eligibility criteria reference data tables comprise a listing of diagnosis codes eligible for supporting the one or more sub-episodes, and (c) generating the sub-episode eligibility listing comprises identifying one or more diagnosis codes existing in both the first parent episode anchor record and the one or more sub-episode eligibility criteria.

4 . The computer-based system of claim 2 , wherein (a) the first parent episode anchor record identifies a procedure code associated with the first parent episode anchor record, (b) the sub-episode eligibility criteria reference data tables comprise a listing of procedure codes eligible for supporting the one or more sub-episodes, and (c) generating the sub-episode eligibility listing comprises identifying one or more procedure codes existing in both the first parent episode anchor record and the one or more sub-episode eligibility criteria.

5 . The computer-based system of claim 2 , wherein the first single-level episode data object identifies a responsible provider for the first single-level episode data object, wherein the sub-episode eligibility criteria reference data tables comprise a listing of provider specialties eligible for supporting the one or more sub-episodes, and wherein the computer-based system is further configured to:

determine a provider specialty associated with the responsible provider from one or more provider specialty tables; and

determine whether the provider specialty of the responsible provider supports the one or more sub-episodes.

6 . The computer-based system of claim 2 , wherein identifying the one or more sub-episode ancillary records further comprises:

identifying a plurality of ancillary records not identified within the episode-specific subset of individual claim records associated with the one or more sub-episode anchor records; and

truncating a first sub-episode date range of a sub-episode data object based at least in part on the parent episode date range and based at least in part on a second sub-episode date range of a second sub-episode associated with the first single-level episode data object such that the first sub-episode date range does not overlap the second sub-episode date range of the second sub-episode.

7 . The computer-based system of claim 2 , wherein identifying the one or more sub-episode anchor records comprises identifying a first sub-episode anchor record and a second sub-episode anchor record; and wherein the computer-based system is further configured to:

generate a sub-episode priority based at least in part on priority scores associated with each of the first sub-episode anchor record and the second sub-episode anchor record;

generate (a) a first sub-episode date range associated with the first sub-episode anchor record and (b) a second sub-episode date range associated with the second sub-episode anchor record; and

truncate one of the first sub-episode date range or the second sub-episode date range based at least in part on the sub-episode priority such that the first sub-episode date range does not overlap the second sub-episode date range.

8 . A computer-implemented method comprising:

storing, by one or more processors and in memory, a plurality of individual claim records, wherein each individual claim record of the plurality of individual claim records has a non-hierarchical data structure;

generating, by the one or more processors, a plurality of single-level episode data objects, each of the plurality of single-level episode data objects relating to an episode-specific subset of individual claim records of the plurality of individual claim records, wherein each single-level episode data object of the plurality of single-level episode data objects identifies a first parent episode record of the episode-specific subset of individual claim records, and wherein the first parent episode record identifies one or more characteristics of a corresponding single-level episode data object;

retrieving, by the one or more processors and based at least in part on data stored within the plurality of single-level episode data objects, a reference table stored in the memory, wherein the reference table comprises a plurality of data entries identifying one or more characteristics of single-level episode data objects that are eligible for supporting one or more sub-episodes;

identifying, by the one or more processors and from the plurality of single-level episode data objects and based at least in part on the reference table, an eligible subset of the plurality of single-level episode data objects eligible for supporting the one or more sub-episodes;

retrieving, by the one or more processors and from the memory, one or more sub-episode eligibility criteria comprising sub-episode eligibility criteria reference data tables;

for a first single-level episode data object of the eligible subset, sequentially generating, by the one or more processors, one or more entries of a sub-episode eligibility listing in the memory based at least in part on characteristics identified for the first single-level episode data object, wherein each of the one or more entries has a corresponding individual claim record associated with the first single-level episode data object;

identifying, by the one or more processors and from the one or more entries, one or more sub-episode records satisfying the one or more sub-episode eligibility criteria;

generating, by the one or more processors, one or more first sub-episode data objects that identify at least one of the one or more sub-episode records;

updating, by the one or more processors, the one or more first sub-episode data objects based at least in part on the one or more characteristics of the first single-level episode data object;

transforming, by the one or more processors, the first single-level episode data object into a multi-level hierarchical data object having metadata tags providing a hierarchical data structure comprising one or more sub-episode identifiers corresponding with the one or more first sub-episode data objects; and

storing, by the one or more processors and into the memory, the multi-level hierarchical data object.

9 . The computer-implemented method of claim 8 , wherein the computer-implemented method further comprises:

identifying, by the one or more processors and from the one or more entries, one or more sub-episode anchor records satisfying the one or more sub-episode eligibility criteria;

identifying, by the one or more processors and from the plurality of individual claim records, one or more sub-episode ancillary records associated with the one or more sub-episode anchor records;

generating, by the one or more processors, one or more second sub-episode data objects that each identifies one of the one or more sub-episode anchor records and the one or more sub-episode ancillary records; and

causing, by the one or more processors and based at least in part on the multi-level hierarchical data object, display of a multi-level view of at least one of the one or more sub-episode anchor records or the one or more sub-episode ancillary records identified by the one or more second sub-episode data objects;

wherein each single-level episode data object of the plurality of single-level episode data objects identifies (a) a parent episode date range indicating an episode start date and an episode end date, (b) a first parent episode anchor record of a plurality of parent episode anchor records that corresponds to the episode-specific subset of individual claim records, wherein each parent episode anchor record of the plurality of parent episode anchor records identifies an episode type of the corresponding single-level episode data object.

10 . The computer-implemented method of claim 9 , wherein (a) the first parent episode anchor record is associated with the first single-level episode data object and comprises data identifying a plurality of diagnosis codes associated with the first parent episode anchor record, (b) the sub-episode eligibility criteria reference data tables comprise a listing of diagnosis codes eligible for supporting the one or more sub-episodes, and (c) generating the sub-episode eligibility listing comprises identifying one or more diagnosis codes existing in both the first parent episode anchor record and the one or more sub-episode eligibility criteria.

11 . The computer-implemented method of claim 10 , wherein the first single-level episode data object identifies a responsible provider for the first single-level episode data object, wherein the sub-episode eligibility criteria reference data tables comprise a listing of provider specialties eligible for supporting the one or more sub-episodes, and wherein the computer-implemented method further comprises:

determining a provider specialty associated with the responsible provider from one or more provider specialty tables; and

determining whether the provider specialty of the responsible provider supports the one or more sub-episodes.

12 . The computer-implemented method of claim 9 , wherein identifying the one or more sub-episode ancillary records further comprises:

identifying a first plurality of ancillary records within the episode-specific subset of individual claim records associated with the one or more sub-episode anchor records;

identifying a second plurality of ancillary records not identified within the episode-specific subset of individual claim records associated with the one or more sub-episode anchor records;

determining a first sub-episode date range based at least in part on the first plurality of ancillary records associated with the one or more sub-episodes; and

truncating the first sub-episode date range based at least in part on the parent episode date range and based at least in part on a second sub-episode date range of a second sub-episode associated with the first single-level episode data object such that the first sub-episode date range does not overlap the second sub-episode date range of the second sub-episode.

13 . The computer-implemented method of claim 9 , wherein identifying the one or more sub-episode anchor records comprises identifying a first sub-episode anchor record and a second sub-episode anchor record; and wherein the computer-implemented method further comprises:

generating a sub-episode priority based at least in part on priority scores associated with each of the first sub-episode anchor record and the second sub-episode anchor record;

generating (a) a first sub-episode date range associated with the first sub-episode anchor record and (b) a second sub-episode date range associated with the second sub-episode anchor record; and

truncating one of the first sub-episode date range or the second sub-episode date range based at least in part on the sub-episode priority such that the first sub-episode date range does not overlap the second sub-episode date range.

14 . The computer-implemented method of claim 8 , wherein generating a single-level episode data object of the plurality of single-level episode data objects comprises storing the corresponding single-level episode data object within temporary storage.

15 . A computer program product comprising one or more non-transitory computer-readable storage media having computer-readable program code portions stored therein, that when executed by one or more processors, cause the one or more processors to:

store, in memory, a plurality of individual claim records, wherein each individual claim record of the plurality of individual claim records has a non-hierarchical data structure;

generate a plurality of single-level episode data objects, each of the plurality of single-level episode data objects relating to an episode-specific subset of individual claim records of the plurality of individual claim records, wherein each single-level episode data object of the plurality of single-level episode data objects identifies a first parent episode record of the episode-specific subset of individual claim records, and wherein the first parent episode record identifies one or more characteristics of a corresponding single-level episode data object;

retrieve, based at least in part on data stored within the plurality of single-level episode data objects, a reference table stored in the memory, wherein the reference table comprises a plurality of data entries identifying one or more characteristics of single-level episode data objects that are eligible for supporting one or more sub-episodes;

identify, from the plurality of single-level episode data objects and based at least in part on the reference table, an eligible subset of the plurality of single-level episode data objects eligible for supporting the one or more sub-episodes;

retrieve, from the memory, one or more sub-episode eligibility criteria comprising sub-episode eligibility criteria reference data tables;

for a first single-level episode data object of the eligible subset, sequentially generate one or more entries of a sub-episode eligibility listing in the memory based at least in part on characteristics identified for the first single-level episode data object, wherein each of the one or more entries has a corresponding individual claim record associated with the first single-level episode data object;

identify, from the one or more entries, one or more sub-episode records satisfying the one or more sub-episode eligibility criteria;

generate one or more first sub-episode data objects that identify at least one of the one or more sub-episode records;

update the one or more first sub-episode data objects based at least in part on the one or more characteristics of the first single-level episode data object;

transform the first single-level episode data object into a multi-level hierarchical data object having metadata tags providing a hierarchical data structure comprising one or more sub-episode identifiers corresponding with the one or more first sub-episode data objects; and

store, into the memory, the multi-level hierarchical data object.

16 . The computer program product of claim 15 , further comprising executable portions configured to:

identify, from the one or more entries, one or more sub-episode anchor records satisfying the one or more sub-episode eligibility criteria;

identify, from the plurality of individual claim records, one or more sub-episode ancillary records associated with the one or more sub-episode anchor records;

generate one or more second sub-episode data objects that each identifies one of the one or more sub-episode anchor records and the one or more sub-episode ancillary records; and

cause, based at least in part on the multi-level hierarchical data object, display of a multi-level view of at least one of the one or more sub-episode anchor records or the one or more sub-episode ancillary records identified by the one or more second sub-episode data objects; and

wherein each single-level episode data object of the plurality of single-level episode data objects identifies (a) a parent episode date range indicating an episode start date and an episode end date, (b) a first parent episode anchor record of a plurality of parent episode anchor records that corresponds to the episode-specific subset of individual claim records, wherein each parent episode anchor record of the plurality of parent episode anchor records identifies an episode type of the corresponding single-level episode data object.

17 . The computer program product of claim 16 , wherein (a) the first parent episode anchor record is associated with the first single-level episode data object and comprises data identifying a plurality of diagnosis codes associated with the first parent episode anchor record, (b) the sub-episode eligibility criteria reference data tables comprise a listing of diagnosis codes eligible for supporting the one or more sub-episodes, and (c) generating the sub-episode eligibility listing comprises identifying one or more diagnosis codes existing in both the first parent episode anchor record and the one or more sub-episode eligibility criteria.

18 . The computer program product of claim 17 , wherein (a) the first parent episode anchor record identifies a procedure code associated with the first parent episode anchor record, (b) the sub-episode eligibility criteria reference data tables comprise a listing of procedure codes eligible for supporting the one or more sub-episodes, and (c) generating the sub-episode eligibility listing comprises identifying one or more procedure codes existing in both the first parent episode anchor record and the one or more sub-episode eligibility criteria.

19 . The computer program product of claim 17 , wherein the first single-level episode data object identifies a responsible provider for the first single-level episode data object, wherein the sub-episode eligibility criteria reference data tables comprise a listing of provider specialties eligible for supporting the one or more sub-episodes, and further comprising executable portions configured to:

determine a provider specialty associated with the responsible provider from one or more provider specialty tables; and

determine whether the provider specialty of the responsible provider supports the one or more sub-episodes.

20 . The computer program product of claim 16 , wherein identifying the one or more sub-episode ancillary records further comprises:

identifying a plurality of ancillary records not identified within the episode-specific subset of individual claim records associated with the one or more sub-episode anchor records; and

truncating a first sub-episode date range of a sub-episode data object based at least in part on the parent episode date range and based at least in part on a second sub-episode date range of a second sub-episode associated with the first single-level episode data object such that the first sub-episode date range does not overlap the second sub-episode date range of the second sub-episode.