Governments as well as health and accident compensation insurers are grappling to improve health outcomes while keeping spiraling costs under control. These seemingly irreconcilable goals require a careful balance of policy to help stem the tide of ever increasing costs in the health industry. Dr Uma Srinivasan CMC Insurance Solutions CMC Lead Scientist Keywords: Health insurance,
The health industry consumes vast amounts of money and resources and is seen as a “black-hole” in many Government budgets. A ground breaking study using new science could save the industry millions and point the way for future research. Dr Shahadat Uddin CMCRC PhD Graduate Lecturer, U. Sydney Shahadat Uddin is a graduate of the
Governments as well as health and accident compensation insurers are grappling to improve health outcomes while keeping spiralling costs under control. These seemingly irreconcilable goals require a careful balance of policy to help stem the tide of ever increasing costs in the health industry. Dr Uma Srinivasan CMC Insurance Solutions CMC Lead Scientist Keywords: Health insurance,
The health industry consumes vast amounts of money and resources and is seen as a “black-hole” in many Government budgets. A ground breaking study using new science could save the industry millions and point the way for future research. Dr Shahadat Uddin CMCRC PhD Graduate Lecturer, U. Sydney Shahadat Uddin is a graduate of the
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
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