Results 1 to 10 of about 562,911 (339)
Health Insurance Claim Review Using Information Technologies [PDF]
Healthcare Informatics Research, 2012 ObjectivesThe objective of this paper is to describe the Health Insurance Review and Assessment Service (HIRA)'s payment request (PARE) system that plays the role of the gateway for all health insurance claims submitted to HIRA, and the claim review ...
Young-Taek Park +4 more
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Fraud Detection in Medical Insurance Claim System using Machine Learning : A Review [PDF]
International Journal of Scientific Research in Computer Science, Engineering and Information Technology, 2022 Since the beginning of the insurance industry, there has been the problem of fraudulent insurance claims. These are a broad variety of illegal activities, the most of which are never uncovered while costing the insurance industry billions of dollars annually. It is estimated that India's insurance industry is suffering losses of around 600–Rs.
Paresh Gohil +2 more
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Left-truncated health insurance claims data: theoretical review and empirical application [PDF]
AStA Advances in Statistical Analysis, 2023 AbstractFrom the inventory of the health insurer AOK in 2004, we draw a sample of a quarter million people and follow each person’s health claims continuously until 2013. Our aim is to estimate the effect of a stroke on the dementia onset probability for Germans born in the first half of the 20th century.
Rafael Weißbach +4 more
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Fraud Detection in Motor Insurance Claims Using Supervised Learning Techniques: A Review
International Journal of Computer and Information Technology(2279-0764), 2023 Fraudulent claims have been a big drawback in motor insurance despite the insurance industry having vast amounts of motor claims data. Analyzing this data can lead to a more efficient way of detecting reported fraudulent claims. The challenge is how to extract insightful information and knowledge from this data and use it to model a fraud detection ...
David Gichohi Maina +2 more
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A Review On Health Insurance Claim Fraud Detection
, 2018 Abstract— The anomaly or outlier detection is one of the applications of data mining. The major use of anomaly or outlier detection is fraud detection. Health care fraud leads to substantial losses of money each year in many countries. Effective fraud detection is important for reducing the cost of Health care system.
Faseela V. S, Dr.P.Thangam
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Physicians’ perception of the reform of the review and assessment system of national health insurance reimbursement claims [PDF]
Journal of the Korean Medical Association, 2022 Background: The Korean government has been promoting the reform of the review and assessment system of national health insurance reimbursement claims. The aim of this study was to find out physicians’ perception and evaluation of the health insurance review and assessment system and present the direction for the government’s reform plan.Methods: The ...
Jung Chan Lee, Kye Hyun Kim
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A Systematic Literature Review of Insurance Claims Risk Measurement Using the Hidden Markov Model
RisksIn the rapidly evolving field of insurance, accurate risk measurement is crucial for effective claims management and financial stability. Therefore, this research presented a systematic literature review (SLR) on insurance claims risk measurement using the Hidden Markov Model (HMM).
Hilda Azkiyah Surya +3 more
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Reducing medical claims cost to Ghana’s National Health Insurance scheme: a cross-sectional comparative assessment of the paper- and electronic-based claims reviews [PDF]
BMC Health Services Research, 2017 A robust medical claims review system is crucial for addressing fraud and abuse and ensuring financial viability of health insurance organisations. This paper assesses claims adjustment rate of the paper- and electronic-based claims reviews of the National Health Insurance Scheme (NHIS) in Ghana.The study was a cross-sectional comparative assessment of
Eric Nsiah-Boateng +6 more
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A Privacy-Preserving Approach to Health Insurance Fraud Detection Using Vertical Federated Learning [PDF]
SensorsIn fraud detection, centralized approaches often face challenges related to data protection, security, and potential data breaches. Such methods require sensitive healthcare and insurance data to be pooled in one location, which increases vulnerability ...
Raghi K R +3 more
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Analysis of the knowledge and insurance screening review rates of health insurance claims in the dental hygienist [PDF]
Journal of Korean society of Dental Hygiene, 2015 Objectives: The purpose of the study is to investigate the level of knowledge and screening review rates of dental health insurance claims in dental hygienists. This analysis will provide the educational information to the dental hygienists. Methods: A self-reported questionnaire was completed by dental hygienists in Jeonbuk from December 17, 2012 to ...
Sin Young Park, Hye Ri Moon
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