The following requirements were considered when updating openIMIS’s Claim adjudication process:
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the default openIMIS Claim adjudication process should be modified as less as possible
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Summary
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Claim AI-based Adjudication System
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{
claim_ai_url: string // URL of the openIMIS instance running Claim-AI module. Default: ""
event_based_activation: boolean // True if the checked Claims are sent to Claim-AI module immediatly after check. Default: False
} |
Claims Preparation
Claim-AI Adjudication Activation Methods
Two activation methods, allowing to start the Claim-AI module processing, are available in the Claim-AI Quality module.
Event-based activation
This activation is based on the openIMIS mutation signal signal_mutation_module_after_mutating SubmitClaimMutation. not actually an activation because
FHIR Contained Resources
FHIR Contained Resources feature (https://www.hl7.org/fhir/references.html#contained) allows to integrate the referred resourced. In our case for FHIR Claim, these are Patient, Condition, Medication, HealthcareService, Practitioner, ActivityDefinition.
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REST API accepting FHIR Claims to categorize them based on a ML model
AI-model execution
REST API
The Claim-AI module will define one endpoint that will receive the FHIR Claim Bundle to be adjudicated. The base URL for this module is /claim_ai
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