Results 81 to 90 of about 248,035 (295)

Medical Knowledge Graph to Enhance Fraud, Waste, and Abuse Detection on Claim Data: Model Development and Performance Evaluation

JMIR Medical Informatics, 2020
BackgroundFraud, Waste, and Abuse (FWA) detection is a significant yet challenging problem in the health insurance industry. An essential step in FWA detection is to check whether the medication is clinically reasonable with respect to the diagnosis ...
Sun, Haixia, Xiao, Jin, Zhu, Wei, He, Yilong, Zhang, Sheng, Xu, Xiaowei, Hou, Li, Li, Jiao, Ni, Yuan, Xie, Guotong   +9 more
doaj   +1 more source

A Systematic Literature Review of Insurance Claims Risk Measurement Using the Hidden Markov Model

Risks
In 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, Sukono Sukono, Herlina Napitupulu, Noriszura Ismail   +3 more
openaire   +2 more sources

A limb to stand on? A scoping review of employability assessment in Australian total and permanent disability insurance claims

Disability and Rehabilitation, 2019
Purpose: Employability assessment helps in deciding to pay or decline Australian total and permanent disability insurance claims, yet it has not been critically examined. This paper reviews employability assessment from forensic vocational assessment, life insurance/superannuation, and legal perspectives.Methods: In a scoping review, we searched six ...
Margaret Black, Lynda R. Matthews, Michael J. Millington   +2 more
openaire   +3 more sources

Risk of new acute myocardial infarction hospitalization associated with use of oral and parenteral non-steroidal anti-inflammation drugs (NSAIDs): a case-crossover study of Taiwan's National Health Insurance claims database and review of current evidence

BMC Cardiovascular Disorders, 2012
BackgroundPrevious studies have documented the increased cardiovascular risk associated with the use of some nonsteroidal anti-inflammatory drugs (NSAIDs). Despite this, many old NSAIDs are still prescribed worldwide.
W. Shau, Hsi-Chieh Chen, Shu-ting Chen, H. Chou, Chia‐Hsuin Chang, Chuei-Wen Kuo, M. Lai   +6 more
semanticscholar   +1 more source

Dimensions of the AI Divide: Digital Inequality and Psychological Consequences

AI &Innovation, EarlyView.
ABSTRACT Artificial intelligence (AI) has become a foundational component of contemporary social, economic, and political life. Yet, the ways in which AI reshapes patterns of exclusion beyond questions of access and technical capability remain insufficiently theorized.
Christos Papaioannou
wiley   +1 more source

Building Linked Big Data for Stroke in Korea: Linkage of Stroke Registry and National Health Insurance Claims Data

Journal of Korean medical science, 2018
Background Linkage of public healthcare data is useful in stroke research because patients may visit different sectors of the health system before, during, and after stroke.
T. J. Kim, Ji Sung Lee, Ji-Woo Kim, M. Oh, Heejung Mo, Chan-Hyuk Lee, Han-Young Jeong, Keun-Hwa Jung, Jae-Sung Lim, S. Ko, K. Yu, Byung‐Chul Lee, B. Yoon   +12 more
semanticscholar   +1 more source

Immigrant mental health, safe work, discrimination, and state policies: From racism and xenophobia to health equity

American Journal of Community Psychology, EarlyView.
Abstract An ecological model was developed to examine the pathways linking immigration state policies to physically safe work conditions and work volition, interpersonal discrimination, and mental health distress. The ecological framework was tested among two subsamples totaling 529 Latinx immigrant participants: (1) immigrants who resided in states ...
Germán A. Cadenas, Thanharat Silamongkol, H. Kenny Nienhusser, Fiorella L. Carlos Chavez, Cristalís Capielo Rosario, Lucas Torres, Oswaldo Moreno   +6 more
wiley   +1 more source

Early Effects of the Serious Accidents Punishment Act on Occupational Health Outcomes in Korea: A Nationwide Difference‐in‐Differences Study (2017–2023)

American Journal of Industrial Medicine, EarlyView.
ABSTRACT Background Work‐related injury and occupational disease remain major public health challenges worldwide; South Korea continues to report comparatively high industrial accident rates among OECD countries. To strengthen managerial accountability for worker safety, the Korean government enacted the Serious Accidents Punishment Act (SAPA) in 2021,
Hyewon Park, Misong Woo, Wanhyung Lee
wiley   +1 more source

Incidence and Comorbidity of Reactive Attachment Disorder: Based on National Health Insurance Claims Data, 2010–2012 in Korea

Psychiatry Investigation, 2017
Objective We aimed to investigate the current diagnostic incidence, and medical and psychiatric comorbidities of reactive attachment disorder (RAD) using the National Health Insurance Review and Assessment (HIRA) claims data.
Minha Hong, D. Moon, Hyejung Chang, Seung Yup Lee, S. Cho, Kyung-Sook Lee, Jin-Ah Park, Sang Min Lee, G. Bahn   +8 more
semanticscholar   +1 more source

“It's Not Deterministic and It Will Never Be Deterministic”: A Qualitative Study on Stakeholder Perspectives of Polygenic Risk Score Testing for Post‐Traumatic Stress Disorder

American Journal of Medical Genetics Part B: Neuropsychiatric Genetics, EarlyView.
ABSTRACT Post‐traumatic stress disorder (PTSD) causes significant mental and physical distress, yet only a small subset of individuals exposed to trauma develop the disorder. Scientists and clinicians are still unable to predict who will get the disorder or how it will manifest.
Brandy M. Fox
wiley   +1 more source