Collaborative artificial intelligence system for investigation of healthcare claims compliance
Marco Luca Sbodio,
Vanessa López,
Thanh Lam Hoang
et al.
Abstract:Healthcare fraud, waste and abuse are costly problems that have huge impact on society. Traditional approaches to identify non-compliant claims rely on auditing strategies requiring trained professionals, or on machine learning methods requiring labelled data and possibly lacking interpretability. We present Clais, a collaborative artificial intelligence system for claims analysis. Clais automatically extracts human-interpretable rules from healthcare policy documents (0.72 F1-score), and it enables profession… Show more
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