MedInsight HCG Grouper

The Milliman MedInsight® HCG Grouper software application categorizes medical and pharmacy claims data into healthcare categories that can be used to analyze and benchmark medical utilization and cost. It is integrated into the MedInsight Analytic Platform, but is also offered as a standalone application.

HCG Grouper leverages Milliman's Health Cost Guidelines™ (HCGs), the industry standard for tracking claim costs by hospital, surgical, medical, and other benefit service categories. HCG research employs multiple sources of data, more than 30 million patients, and more than 2 billion claim records across data sets from both the public and private sector.

HCGs can be used to adjust national average healthcare costs for specific geographic areas, benefits, reimbursement structures, and plan characteristics. Traditional health insurers, managed care organizations, and third-party administrators find them valuable for product evaluation and pricing.

The HCG Grouper application utilizes HCGs to assign detailed information to claims. Each line of claim detail is assigned an HCG service cost category, number of admits or cases, number of days or procedures, and procedure grouped families, as well as identification of continuous stay claims.


The HCG Grouper application helps quantify your organization's performance and can be used to analyze cost and utilization for many different types of population data, such as product lines, line of business, employer groups, primary care panels, disease populations, and many others. The ability to categorize healthcare claims data is useful for many purposes, including:

The results from the tool are used throughout client organizations, from actuarial services to medical management programs, employer group reporting, and executive level management reporting.


The HCG Grouper provides five values that seamlessly integrate into a client’s data warehouse or data mart:

  1. HCG category identifier
  2. Days/procedures – utilization metrics for all HCGs
  3. Admits/case – utilization metrics for all HCGs
  4. Continuous stay claim ID – a key value to be used for analysis of inpatient claims
  5. Milliman procedure code family – a Milliman methodology to categorize and aggregate all procedure codes into 46 families

Claims are input through the Grouper in a flat file and results are returned in the same format.

The output format and design lend themselves to flexible integration with the vast majority of commercially available databases or analytical applications. The data may also be imported into an existing data warehouse to be readily utilized in reporting functionality.

Translation or mapping of client proprietary service category methodologies to the HCG methods can be provided as a complementary service.


The HCG Grouper application is compatible with Microsoft Windows operating systems and can be installed in a matter of minutes. The standard license agreement covers assistance with implementation, training, and annual support.

Learn more

If you are seeking to improve quality of care while containing costs, contact us to learn more about the HCG Grouper and the wealth of expertise, data management, and analytic technology that Milliman offers. We would be happy to meet with your team to discuss your needs and our capabilities.

To receive more information, please contact Todd Fessler, MedInsight Sales and Marketing Director.

Learn More

To receive more information, please contact Todd Fessler, MedInsight Sales and Marketing Director.

Phone: +1 206.504.5516

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