Hey there, fellow data enthusiasts! I’m currently trying to build a way to estimate claims amounts using medical data. I’ve created two tables to tackle this challenge. Table A holds hospital information, including contract IDs, dates of service, bill charges, and diagnosis codes. Table B is a contract rate table, which includes hospital information, service descriptions, payment methodologies, and dates of contract validity.
The problem I’m facing is that there are numerous services included and excluded depending on the contract. My current approach is only giving me an estimated payment for all services, but I need a more precise output. Am I on the right track, or am I way off?
To break it down, I need to find a way to accurately estimate claims amounts by considering the intricacies of each contract. This means accounting for services included and excluded, as well as the corresponding payment methodologies. Has anyone tackled a similar challenge? Any guidance or advice would be greatly appreciated.