Systems and methods for a network analyzer tool
View Patent ↗The present solution provides a new tool to assist clients and prospects in evaluating and optimizing their use of PPO networks. The interactive analysis tool of the present solution allows you to rapidly see the impact of different network configurations based on actual experience measured against a comprehensive bill review database.
1. A method for evaluating efficiency of billing of services via a health care provider network, the method comprising:
(a) receiving, by a tool executing on a device, a first selection of a healthcare provider network from a plurality of health care provider networks;
(b) receiving, by the tool, a second selection of a state for which services were provided by the selected health care provider network; and
(c) determining, by the tool via a database of reviewed bill data, a penetration and a savings for bills on services within the state for the selected health care provider network, the tool determining the penetration as a total of bill reviewed charges billed to the selected health care provider network divided by a total of bill reviewed charges billed to a plurality of health care provider networks.
2. The method of claim 1 , wherein step (a) further comprises receiving, by the tool, the selection of the healthcare provider network comprising a preferred provider organization (PPO).
3. The method of claim 1 , wherein step (a) further comprises receiving, by the tool, identification of a time period for determining a penetration efficiency and savings.
4. The method of claim 3 , wherein step (c) further comprises determining, by the tool, the penetration efficiency and the savings for bills on service within the state for the selected health care provider network during the time period.
5. The method of claim 1 , wherein step (b) further comprises receiving, by the tool, the second selection of the state from a plurality of states in which the healthcare provider network provides services.
6. The method of claim 1 , wherein step (a) further comprises receiving, by the tool, a third selection of a second health care provider network.
7. The method of claim 6 , wherein step (c) further comprises determining, by the tool, the penetration and the savings for bills on service within the state for the second health care provider network.
8. The method of claim 1 , wherein step (c) further comprises determining, by the tool, the savings by dividing a reduction for the selected health care provider by a total amount billed to the selected health care provider network.
9. The method of claim 1 , wherein step (c) further comprises determining, by the tool, the penetration and the savings on a per service class basis for the selected health care provider network.
10. The method of claim 1 , wherein step (c) further comprises determining, by the tool, the penetration and the savings on a per service class basis for the selected health care provider network and excluding one or more service classes selected from a plurality of service classes.
11. The method of claim 1 , wherein step (c) further comprises determining, by the tool, a network efficiency based on the penetration and the savings.
12. A method for evaluating efficiency of selectable health care providers from a plurality of healthcare provider networks, the method comprising:
(a) receiving, by a tool executing on a device, a first selection of a first healthcare provider network of a plurality of healthcare provider networks;
(b) receiving, by the tool, a second selection of a second healthcare provider network of a plurality of healthcare provider networks;
(c) determining, by the tool, a penetration for each of the first healthcare provider network and the second healthcare provider network, the tool determining the penetration as a total of bill reviewed charges billed to a selected health care provider network divided by a total of bill reviewed charges billed to the plurality of healthcare provider networks; and
(d) comparing, by the tool, efficiency of billing of services between the first health care provider network and the second healthcare provider network, wherein the efficiency is calculated for each of the first healthcare provider network and the second healthcare provider network as a product of a corresponding reduction and penetration divided by 10.
13. The method of claim 12 , wherein step (a) further comprises receiving, by the tool, a selection of a state from a plurality of states in which the first healthcare provider network provided services.
14. The method of claim 12 , wherein step (a) further comprises receiving, by the tool, identification of a time period for the comparison.
15. The method of claim 12 , wherein step (b) further comprises receiving, by the tool, the second selection of the second healthcare provider network of the plurality of healthcare provider networks for a same state as the first healthcare provider network.
16. The method of claim 12 , wherein step (c) further comprises determining, by the tool from the database of reviewed bills, for each of the first healthcare provider network and the second healthcare provider network a network penetration and a network savings based on charges allowed via bill review.
17. The method of claim 12 , wherein step (c) further comprises determining, by the tool from the database of reviewed bills, for each of the first healthcare provider network and the second healthcare provider network, the efficiency based on charges allowed via bill review.
18. The method of claim 12 , further comprises receiving, by the tool, a selection of a client from a plurality of clients.