High-Cost Medical Claim Prediction and Navigation Engine

原文（中文）

A prediction and navigation engine that identifies in real-time new workers' compensation cases likely to be high-cost-sometimes referred to as outliers. The engine employs artificial intelligence (AI), machine learning (ML) and natural language processing (NLP) on the entries of the adjuster notes to do so, sending a warning back to the program or system into which the adjuster is typing those notes if the engine identifies the case as a potential outlier. The engine then predicts the likely costs of each new case, whether a potential outlier or not, by comparing the keywords, phrases and text that the adjuster uses in the initial and/or earlier in time notes for that new case, combined with any other available information, against the adjuster notes and actual costs of similar historical cases in the engine's library.