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Patients with no claim for carotid imaging were excluded from linear regression and K-means analyses because the carotid imaging date is needed to correctly label symptom and review stage activities (e.g. neuro vs. neuroREV). Process analysis by research question RQ1: Algorithmic process discovery...
Identifying specific claim line details that underpin the fraud is also challenging, given that such billing discrepancies often pertain to the overall behavior of the provider. Therefore, in our study we employ the unsupervised methods in combination with rule-based approach for detection to mitigate...
Flow chart illustrating the process of creating the cohort. Premature infants with a gestational age (GA) < 37 weeks who were born between 2007 and 2018 were enrolled.GAgestational age,ROPretinopathy of prematurity. Full size image
the cost of a false positive (wrongly flagging a legitimate claim as fraudulent) can be vastly different from that of a false negative (failing to detect an actual fraudulent claim). In a healthcare insurance context, the latter might lead to substantial financial losses and undermine the integr...
One of the main issues is that they purposefully operate in a gray area where they make all the rules. Anyone can claim to pay 100% of “eligible” expenses, as long as they get to define “eligible”. The “non-profit” executives can also pay other businesses affiliated with themselves...
A total of 9,238 records of policy information of all customers who opened accounts since 1999 and 1,484 records of claim information of additional insurance claims of the above customers as of October 2005 were extracted. In order to make insurance enterprises have a qualitative leap and a ...
Deliver same- or next-day claim payouts from a single digital system. Offer prepaid and filtered spend cards for safer, faster and fewer payouts. Process payments easily across borders with the world’s No. 1 global acquiring service. Quickly implement self-service portals with help from our ma...
19. The computer system of claim 18, wherein the legacy system processor is configured to perform a rating process in response to receipt of user input via the web server system and the dispatcher system. 20. The computer system of claim 18, wherein the processor of the dispatcher system ...
as the shipping carrier will only deal with the party (i.e. the seller) that purchased the insurance policy. This presents a number of challenges to sellers. Other companies enable a seller to buy insurance. However, the claim process for the insurance provided by these services is complicated...