Processing health insurance data utilizing data quality rules
In a system and method for processing data, a user interface enables a user to enter mapping data to enable incoming data to be converted to a common data format. A database stores the mapping data and data quality rules, and a receiver receives data from a data source. The processor applies the data quality rules to the common format data to identify any potential errors in the common format data and notifies the user of any potential errors found in the common format data. The data rules may include data structure rules and/or data trending requirements based upon data trends or norms. The data source may be an employer, insurance company or other entity. The data may include insurance claim data, medical data and/or prescription data and/or eligibility and/or occupational and non-occupational data.
1. A computer-implemented system for processing data, comprising:
a user interface for enabling a user to enter mapping data to enable incoming health insurance data to be converted to a common data format;
a database for storing the mapping data and data quality rules, wherein the data quality rules include data quality structure rules and data trending requirements;
a receiver for receiving data from a data source; and
a computer processor for automatically formatting the received data into the common data format using the mapping data input by the user to create common format data, wherein the computer processor applies the data quality rules to the common format data to identify potential errors in the common format data and notifies the user of any common format data containing one or more potential errors to enable the user to resolve the one or more potential errors in the common format data to complete quality checking of the common format data,
wherein the user may redefine the mapping data or data quality rules to enable acceptance of values in the common format data identified as containing the one or more potential errors.
2. The system according to claim 1 , wherein the data source is an employer or other supplier providing raw data concerning its employees.
3. The system according to claim 1 , wherein the user may accept or reject the common format data containing potential errors, wherein rejected common format data is removed from the common format data.
4. A computer-implemented method for processing data, comprising:
receiving mapping data entered by a user via a user interface to enable incoming health insurance data to be converted to a common data format;
storing the mapping data and data quality rules in a database, wherein the data quality rules include data quality structure rules and data trending requirements;
receiving data from a data source at a computer processor;
formatting the received data into the common data format using the mapping data input by the user to create common format data, wherein the formatting is performed by the computer processor;
using the computer processor to apply the data quality rules to the common format data to identify potential errors in the common format data;
using the computer processor to notify the user of any common format data containing one or more potential errors; and
receiving at the computer processor instructions input by the user to resolve the one or more potential errors in the common format data to complete quality checking of the common format data,
wherein the user may redefine the mapping data or data quality rules to enable resolution of the one or more potential errors in the common format data.
5. The method according to claim 4 , wherein the data source is an employer providing raw data concerning its employees.
6. The method according to claim 4 , wherein the user instructions may accept or reject the common format data containing potential errors, wherein rejected common format data is removed from the common format data.