Medical insurance claims are of organized crimes related to patients, physicians, diagnostic centers, and insurance providers, forming a chain reaction that must be monitored constantly. These kinds of frauds affect the financial growth of both insured people and health insurance companies. The Convolution Neural Network architecture is used to detect fraudulent claims through a correlation study of regression models, which helps to detect money laundering on different claims given by different providers. Supervised and unsupervised classifiers are used to detect fraud and non-fraud claims.
MasonNLP+ at SemEval-2023 Task 8: Extracting Medical Questions, Experiences and Claims from Social Media using Knowledge-Augmented Pre-trained Language Models
Interpretable (not just posthoc-explainable) medical claims modeling for discharge placement to prevent avoidable all-cause readmissions or death
Mederrata Research and Sound Prediction(Mederrata研究与声音预测公司);NIH NIDDK(美国国立卫生研究院国家糖尿病、消化与肾脏疾病研究所);Mederrata Research(Mederrata研究公司);Blue Health Intelligence(蓝色健康智能公司);Walter Reed Army Institute of Research(沃尔特·里德陆军研究所);Sound Prediction and Mederrata Research(声音预测与Mederrata研究公司)
Machine learning using longitudinal prescription and medical claims for the detection of nonalcoholic steatohepatitis (NASH)
IQVIA(艾昆纬)
目的开发和评估机器学习模型,以检测疑似未确诊的非酒精性脂肪性肝炎(NASH)患者,用于诊断筛查和临床管理。方法在这项回顾性观察性非干预性研究中,使用来自1,463,089例患者的行政医疗索赔数据,训练梯度提升决策树,以从具有肥胖、2型糖尿病(T2 DM)、代谢紊乱或非酒精性脂肪肝(NAFL)病史的高危患者人群中检测可能的NASH患者。对模型进行训练,以检测所有风险患者或既往无NAFL诊断的亚组(非NAFL风险患者)中可能的NASH。使用回顾性医疗索赔数据对模型进行训练和验证,并使用精确召回面积和受试者工作特征曲线(AUPRC,AUROC)进行评估。在索赔数据中,NASH的6个月发病率为1/1,437例高危患者和1/2,127例非NAFL高危患者。训练用于检测所有风险患者中NASH的模型的AUPRC为0.0107(95% CI 0.0104 - 0.011),AUROC为0.84。在10%的召回率下,模型精度为4.3%,是NASH发病率的60倍。训练用于检测非NAFL患者中NASH的模型的AUPRC为0.003(95% CI 0.0029 - 0.0031),AUROC为0.78。在10%的召回率下,模型精度为1%,是NASH发病率的20倍。结论NASH在医疗索赔数据中的低发生率证实了NASH在临床实践中的漏诊模式。基于索赔的机器学习可以促进检测可能的NASH患者,以进行诊断测试和疾…
A Nationwide Japanese Medical Claims Foundation Model: Balancing Model Scaling and Task-Specific Computational Efficiency
Graduate School of Medicine, Kyoto University(京都大学医学研究科);Medical Data Vision Co., Ltd.(医疗数据视觉株式会社);IQVIA Solutions Japan G.K.(IQVIA日本解决方案公司);DeSC Healthcare, Inc.(DeSC医疗公司)