Claims Analytics — Pipeline Skill

Overview

Provide deterministic, copy-paste-ready Python and SQL code for healthcare claims data processing: X12 parsing, code manipulation, provider profiling, outlier detection, NCCI edit validation, and duplicate claim identification.

Usage

• Parse X12 837/835 claim files into structured DataFrames
• Profile provider billing patterns and detect outliers (E&M upcoding, impossible days)
• Validate claims against NCCI edits and detect duplicate submissions

Core Concepts