Clinical Decision Support (CDS) provides clinicians, staff, and patients with patient information, usually at the point of care. Clinical Decision Support takes over many routine tasks from clinicians and flags potential problems and solutions for the medical team and patient.
Machine learning models, referred to as EHRs (electronic health records) or EMRs (electronic medical records), help clinicians better manage patient health records through population management, diagnostics and smart documentation. Clinicians also use these models to perform other clinical tasks.
Insurance claims management is the process of managing a claim from reception to settlement. The insurance claim process is particularly suited to machine learning solutions as much can be done to cut time and costs, leading to speedier resolution of claims to the satisfaction of both insurer and insured.
Insurance fraud can be committed by either the buyer or the seller of an insurance policy.
The seller may offer policies from non-existent companies, fail to submit premiums, and churn policies to create more commissions. The buyer exaggerate claims, falsify medical history, post-date policies, sell their policy to for cash when they are diagnosed with a terminal disease, or fake their death or kidnapping. We will focus on the buyer insurance fraud in this post.