Health insurance companies can take two approaches when making decisions. They make actuarial decisions (Based on rules-based statistical analysis), or they can go on their gut feeling. The people in healthcare insurance doing these mathematical and statistical calculations are called actuaries.
Health Insurance providers bill Insurance companies by utilizing a charge description master (CDM). CDM is a massive and comprehensive list of every procedure. Each item has associated codes for billing and tracking purposes. While a patient undergoes treatment at a hospital, each procedure is documented, and a code for records and claim submission is generated.
After a claim is submitted, the health insurance company decides how much to pay the healthcare provider. This process is referred to as claims adjudication. The insurer may pay the claim in full, deny the claim, or it can reduce the amount paid to the provider. After an insurer receives a claim, they typically follow a five-step process: initial processing review, automatic review, manual review, payment determination, and payment.
Information retrieval is difficult because it can come in multiple different forms. It can come in the form of voice, text, and images. It can also come from implicit searches.
The healthcare industry is rapidly changing and will need to deliver better care at better prices in the future. Healthcare professionals are resorting to futuristic tools like Big Data and Analytics to drive innovation along with new medicines.
Data related to the healthcare industry is estimated to undergo a CAGR (compound annual growth rate) of 36% by 2025. With this significant growth, the prospective benefits of big data in healthcare are unquestionable…