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• ClaimFilterMedicalItem allows Medical Officers to filter the Claims list based on a specific Medical Item (only one from autocomplete list)

• ClaimFilterMedicalService allows Medical Officers to filter the Claims list based on a specific Medical Service (only one from autocomplete list)

• ClaimFilterAIProcessed allows Medical Officers to display or hide the non AI-processed Claims (checkbox, decision if this is hidden or not default checked)

AI Categorisation Misclassification Report

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• accuracy scores

• number of True Positives results

• number of True Negative results

• number of False Positive results

• number of False Negative results

• Table with Claim that were fixed (ClaimItem.json_ext.claim_ai_quality.ai_result != ClaimItem.ClaimItemStatus - same for ClaimService)

  • ClaimCode

  • CHFID (Insuree number)

  • ICDID (check if name can be entered)

  • Date from-to (DateFrom - DateTo)

  • Total items (ClaimItems + ClaimServices)

  • Fixed items

  • Reviewed date (ValidityFromReview)

  • Reviewed by (AuditUserIDReview → Username)

To generate this report, the user will have have to filter through the Review Claims search form and trigger the report through a button (label is “AI Misclassification Report”). Only the filtered Claims will be considered for the report.

The button should be hidden if ClaimStatus is Entered or Checked.

Deployment architecture

The two modules should be implemented as follow:

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