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Deployment architecture

Claim-AI Quality Module

Claim-AI Quality Responsibilities

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

• Listening for <<signal_mutation_module_after_mutating>> SubmitClaimsMutation

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

• Contribute to Claim Review Search based on the custom fields

• Defines a scheduled task to convert openIMIS Claims to FHIR Claims and POST to Claim-AI

• Receive FHIR ClaimResponse

• Update Claim Status ClaimItem and ReviewStatusClaimServices status

• Reports claim adjudication misclassifications

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• claim_ai to add information on Claim. The field was_categorized allow to filter automatically checked Claim that have not been categorized by AI and ‘hide’ them for manual adjudication.

  Code Block
  language json
  "json_ext": { "claim_ai_quality": { "was_categorized": "boolean", // whether the claim has been categorized by Claim-AI module or not "request_time": "datetime", // time when the claim has been sent to Claim-AI module "response_time": "datetime" // time when the claim adjudication response has been received from Claim-AI module } }

• 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" // claim adjudication value provided by Claim-AI module (for misclassification report) } }

Because ClaimItem and ClaimService doesn’t extend the ExtendableModel, this change is also made to allow custom fieldssupport custom fields, these classes need to be extended with ExtendableModel class.

Claim-AI Module

Claim-AI Responsibilities

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