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A FRAMEWORK FOR ADMINISTRATIVE CLAIM DATA TO EXPLORE HEALTHCARE COORDINATION AND COLLABORATION

by sofia | Posted on

Previous studies have documented the application of electronic health insurance claim data for health services research purposes. In addition to administrative and billing details of healthcare services, insurance data reveal important information regarding professional interactions/links that emerge among healthcare service providers through, for example, informal knowledge sharing. By utilising details of such professional interactions and

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LEVERAGING BIG DATA ANALYTICS TO REDUCE HEALTHCARE COSTS

by sofia | Posted on

The healthcare sector deals with large volumes of electronic data related to patient services. This article describes two novel applications that leverage big data to detect fraud, abuse, waste, and errors in health insurance claims, thus reducing recurrent losses and facilitating enhanced patient care. The results indicate that claim anomalies detected using these applications help

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