Results 221 to 230 of about 564,598 (265)
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Fraud detection in automobile insurance claims: A statistical review
Developments of Artificial Intelligence Technologies in Computation and Robotics, 2020Automobile insurance fraud detection has become critically important for reducing the costs of insurance companies. This survey paper categorises, compares, and summarises from almost all published data mining-based technical and review articles in automated automobile insurance fraud detection.
Liu, Xi, Yang, Jian-Bo, Xu, Dong-Ling
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The Antitrust Bulletin, 2023
We provide a methodology for geographic market definition when the product(s) being purchased or sold has an intrinsic geographic component, such as (1) the sale of commercial health plans and (2) the purchase of health care providers’ services by commercial health plans.
Haas-Wilson, Deborah +2 more
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We provide a methodology for geographic market definition when the product(s) being purchased or sold has an intrinsic geographic component, such as (1) the sale of commercial health plans and (2) the purchase of health care providers’ services by commercial health plans.
Haas-Wilson, Deborah +2 more
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Using Insurance Claims Data and Medical Record Reviews to Assess the Quality of Medical Care
Journal For Healthcare Quality, 1997This article examines the possibilities and limitations of using computerized insurance claims and outpatient medical records to evaluate a Medicaid managed care program. The quality of medical care delivered to enrollees 1 1/2 years into the MassHealth managed care program's operation is discussed in the context of an evaluation that was conducted by ...
C H, Ellenbecker +2 more
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Review on use of German health insurance medication claims data for epidemiological research
Pharmacoepidemiology and Drug Safety, 2009AbstractPurposeThe objective was to evaluate the use of German health insurance claims data on medications over the last 10 years by a review of published studies.MethodsPubMed and Scopus were searched for relevant studies published in 1998 through 2007.ResultsA total of 70 studies were included.
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[Claim review in occupational disability insurance].
Versicherungsmedizin, 1995In a deregulated market characterised by increasing competitiveness and improved conditions, care in assessing proposals in additional disability benefits will take on an even more significant role. The assessment has to be based on overall analysis of the moral and objective risk.
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Jurnal Meta Hukum
Motor vehicle damage due to accidents, then every owner and driver cannot be sure what will happen in the future so that it is insured. It is concluded that the insured's obstacles in submitting a claim if there is a risk of accident in the motor vehicle insurance agreement at PT.
Irwan Fauzi, Tri Reni Novita
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Motor vehicle damage due to accidents, then every owner and driver cannot be sure what will happen in the future so that it is insured. It is concluded that the insured's obstacles in submitting a claim if there is a risk of accident in the motor vehicle insurance agreement at PT.
Irwan Fauzi, Tri Reni Novita
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Health Services Management Research, 1993
This paper describes the development of a claim review and payment model utilizing the diagnosis related groups (DRGs) for the fee for service-based payment system of the Korean health insurance. The present review process, which examines all claims manually on a case-by-case basis, has been considered to be inefficient, costly, and time-consuming ...
Y S, Shin, Y K, Yeom, H, Hwang
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This paper describes the development of a claim review and payment model utilizing the diagnosis related groups (DRGs) for the fee for service-based payment system of the Korean health insurance. The present review process, which examines all claims manually on a case-by-case basis, has been considered to be inefficient, costly, and time-consuming ...
Y S, Shin, Y K, Yeom, H, Hwang
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The psychiatrist and health insurance claims review.
The Journal of clinical psychiatry, 1978Expanded health insurance benefits for the treatment of mental illness have obliged psychiatrists to devote more time to justifying psychiatric treatment to claims reviewers. The author, drawing from experience in utilization review and peer review, summarizes factors contributing to the denial of payment for psychiatric services by health insurers ...
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Journal of Advances in Developmental Research
: Health Insurance (HI) pays for medical as well as surgical expenditures incurred by the insured person, thereby rendering financial safety against the expensive costs related to Healthcare (HC) services. HC costs are effectively managed via the process of Healthcare Insurance Claims (HICs), where insured individuals submit claims to their insurance ...
Vineet KR Mishra - +2 more
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: Health Insurance (HI) pays for medical as well as surgical expenditures incurred by the insured person, thereby rendering financial safety against the expensive costs related to Healthcare (HC) services. HC costs are effectively managed via the process of Healthcare Insurance Claims (HICs), where insured individuals submit claims to their insurance ...
Vineet KR Mishra - +2 more
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Fraud Detection in Insurance Claim System: A Review
2022 Second International Conference on Artificial Intelligence and Smart Energy (ICAIS), 2022Sandip Vyas, Shilpa Serasiya
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