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Claim adjudication process
Use cases
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Updated Claim Status
The following state diagram from Figure 1 corresponds to the Claim fields status with the updated adjudication process.
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Deployment architecture
| Plantumlcloud |
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| filename | openIMIS-AI-Modules-Deployment.png |
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| Plantumlcloud |
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| filename | ClaimAIExec.png |
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Because ClaimItem and ClaimService doesn’t support custom fields, these classes need to be extended with ExtendableModel class.
Migrations
Because the Claim-AI modules are activated after Claims have been adjudicated (the data used for the training), a migration script needs to be created to insert the JSON fields into the available data. The following initializations will be used:
| Code Block |
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Claim.json_ext.claim_ai_quality.was_categorized = true
Claim.json_ext.claim_ai_quality.request_time = Claim.ValidityFromReview
Claim.json_ext.claim_ai_quality.response_time = Claim.ValidityFromReview
ClaimService.json_ext.claim_ai_quality.ai_result = ClaimService.ClaimServiceStatus
ClaimItem.json_ext.claim_ai_quality.ai_result = ClaimItem.ClaimItemStatus |
Claim-AI Module
Claim-AI Responsibilities
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