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• Contribute to Claim Review Search with Medical Item/Service filter

• Listening for <<signal_mutation_module_after_mutating>> SubmitClaimsMutation

• Prepare the new checked claims for AI categorisation (not to be selected by reviewers)

• Convert openIMIS Claims to FHIR Claims and POST to Claim-AI

• Receive FHIR ClaimResponse

• Update Claim Status and ReviewStatus

• Reports claim adjudication misclassifications

Models

The following JSON extension extensions will be created to support the Claim AI-based Categorisation:

• claim_ai to add information on Claim

  Code Block
  "json_ext": { "claim_ai_quality": { "was_categorized": "boolean", "request_time": "datetime", "response_time": "datetime" } }

• claim_ai_item to add information on ClaimItem and ClaimService. This is used to store AI categorisation result to allow the misclassification report.

  Code Block
  "json_ext": { "claim_ai_quality": { "ai_result": "integer" } }

Because ClaimItem and ClaimService doesn’t extend the ExtendableModel, this change is also made to allow custom fields.

Claim-AI Module

Claim-AI Responsibilities

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