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Adjudicate Claims with AI
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Use Case
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Deployment architecture
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Claim-AI Quality Module
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Pushing Claims to Claim-AI Module
Connecting to the Claim-AI Instance
Because the communication is done through WebSocket protocol, the Claim-AI Quality module needs first to connect to the Claim-AI module. This connection is persistant and is
Build FHIR Claim Bundle
The Claim-AI module is accepting FHIR Claim Bundle resource and respond with FHIR ClaimResponse Bundle resource (see REST API). Before calling the Claim-AI REST API, we are transforming all prepared Claims to FHIR Claim Bundle (see partition Build FHIR-Claim Bundle in AI-based Claim Adjudication Process).
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Claim-AI Responsibilities
REST WebSocket API accepting FHIR Claims to categorize them based on a ML model
AI-model execution
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WebSocked API
The Claim-AI module will define the following endpoints. The base URL for this module is /claim_ai
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