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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, Jeong-Sik Yoon, Stuart M. Speedie, Hojung Yoon, Jiseon Lee   +4 more
doaj   +5 more sources

The Potential and Uptake of Remote Sensing in Insurance: A Review [PDF]

Remote Sensing, 2014
Global insurance markets are vast and diverse, and may offer many opportunities for remote sensing. To date, however, few operational applications of remote sensing for insurance exist.
Jan de Leeuw, Anton Vrieling, Apurba Shee, Clement Atzberger, Kiros M. Hadgu, Chandrashekhar M. Biradar, Humphrey Keah, Calum Turvey   +7 more
doaj   +5 more sources

A Privacy-Preserving Approach to Health Insurance Fraud Detection Using Vertical Federated Learning [PDF]

Sensors
In 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, Arjun Paramarthalingam, Harini Kanthan, Mahalakshmi Karthiban   +3 more
doaj   +2 more sources

COVID-19 International Collaborative Research by the Health Insurance Review and Assessment Service Using Its Nationwide Real-world Data: Database, Outcomes, and Implications [PDF]

Journal of Preventive Medicine and Public Health, 2021
This article aims to introduce the inception and operation of the COVID-19 International Collaborative Research Project, the world’s first coronavirus disease 2019 (COVID-19) open data project for research, along with its dataset and research method, and
Yeunsook Rho, Do Yeon Cho, Yejin Son, Yu Jin Lee, Ji Woo Kim, Hye Jin Lee, Seng Chan You, Rae Woong Park, Jin Yong Lee   +8 more
doaj   +1 more source

Estimation of the Number of Patients With Mitochondrial Diseases: A Descriptive Study Using a Nationwide Database in Japan

Journal of Epidemiology, 2023
Background: To provide a better healthcare system for patients with mitochondrial diseases, it is important to understand the basic epidemiology of these conditions, including the number of patients affected.
Koki Ibayashi, Yoshihisa Fujino, Masakazu Mimaki, Kenji Fujimoto, Shinya Matsuda, Yu-ichi Goto   +5 more
doaj   +1 more source

Studies of Health Insurance Claims Data in Japan: A Scoping Review

JMA Journal, 2023
Health insurance claims data are used in various research fields; however, an overview on how they are used in healthcare research is scarce in Japan. Therefore, we conducted a scoping review to systematically map the relevant studies using Japanese claims data.MEDLINE, EMBASE, and Ichushi-Web were searched up to April 2021 for studies using Japanese ...
Suto, Maiko, Sugiyama, Takehiro, Imai, Kenjiro, Furuno, Takashi, Hosozawa, Mariko, Ichinose, Yuichi, Ihana-Sugiyama, Noriko, Kodama, Tomoko, Koizumi, Ryuji, Shimizu-Motohashi, Yuko, Murata, Shunsuke, Nakamura, Yayoi, Niino, Mariko, Sato, Misuzu, Taguchi, Reina, Takegami, Misa, Tanaka, Motoko, Tsutsumimoto, Kota, Usuda, Kentaro, Takehara, Kenji, Iso, Hiroyasu   +20 more
openaire   +2 more sources

Left-truncated health insurance claims data: theoretical review and empirical application

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, Achim Dörre, Dominik Wied, Gabriele Doblhammer, Anne Fink   +4 more
openaire   +4 more sources

Critical Performance Analysis of The Health Insurance Sector In India During Covid-19 Outbreak

Asia Pacific Journal of Health Management, 2022
Introduction: Health insurance is one of the main non-life insurance sectors, which contributes nearly 29% of general insurance premium income. Almost every industry in the world has been affected by the COVID-19 outbreak and its associated lockdowns ...
Babita Yadav, Sukhmeet Kaur, Saloni Devi, Sanjay Manocha   +3 more
doaj   +1 more source

Costs of Severe Maternal Morbidity in U.S. Commercially Insured and Medicaid Populations: An Updated Analysis

Women's Health Reports, 2021
Background: The most common reason for hospitalization in the United States is childbirth. The costs of childbirth are substantial. Materials and Methods: This was a retrospective cohort study of hospital deliveries identified in the MarketScan ...
Christopher M. Black, Kimberly K. Vesco, Vinay Mehta, Pamela Ohman-Strickland, Kitaw Demissie, Dona Schneider   +5 more
doaj   +1 more source

The trust and insurance models of healthcare purchasing in the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana in India: early findings from case studies of two states

BMC Health Services Research, 2022
Background The Pradhan Mantri Jan Arogya Yojana (PMJAY), a publicly funded health insurance scheme for the poor in India, was launched in 2018. Early experiences of states with various purchasing arrangements can provide valuable insights for its future ...
Kheya Melo Furtado, Arif Raza, Devasheesh Mathur, Nafisa Vaz, Ruchira Agrawal, Zubin Cyrus Shroff   +5 more
doaj   +1 more source