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INTERNATIONAL JOURNAL OF NOVEL RESEARCH AND DEVELOPMENT International Peer Reviewed & Refereed Journals, Open Access Journal ISSN Approved Journal No: 2456-4184 | Impact factor: 8.76 | ESTD Year: 2016 Scholarly open access journals, Peer-reviewed, and Refereed Journals, Impact factor 8.76 (Calculate by google scholar and Semantic Scholar | AI-Powered Research Tool) , Multidisciplinary, Monthly, Indexing in all major database & Metadata, Citation Generator, Digital Object Identifier(DOI) |
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| Paper Title: | IDENTIFYING HEALTH INSURANCE CLAIM FRAUDS USING MIXTURE OF CLINICAL CONCEPTS |
| Authors Name: | Mrs R. Jhansi rani , J. Jaya Prakash |
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| Author Reg. ID: |
IJNRD_207266
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| Published Paper Id: | IJNRD2311005 |
| Published In: | Volume 8 Issue 11, November-2023 |
| DOI: | |
| Abstract: | Patients depend on health insurance provided by the government systems, private systems, or both to utilize the high-priced healthcare expenses. This dependency on health insurance draws some healthcare service providers to commit insurance frauds. Although the number of such service providers is small, it is reported that the insurance providers lose billions of dollars every year due to frauds. In this article, we formulate the fraud detection problem over a minimal, definitive claim data consisting of medical diagnosis and procedure codes. We present a solution to the fraudulent claim detection problem using a novel representation learning approach, which translates diagnosis and procedure codes into Mixtures of Clinical Codes (MCC). We also investigate extensions of MCC using Long Short Term Memory networks and Robust Principal Component Analysis. Our experimental results demonstrate promising outcomes in identifying fraudulent records |
| Keywords: | Insurance,Medical diagnostic imaging,Medical services,Encoding,Principal component analysis,Industries,Bayes methods |
| Cite Article: | "IDENTIFYING HEALTH INSURANCE CLAIM FRAUDS USING MIXTURE OF CLINICAL CONCEPTS", International Journal of Novel Research and Development (www.ijnrd.org), ISSN:2456-4184, Vol.8, Issue 11, page no.a47-a54, November-2023, Available :http://www.ijnrd.org/papers/IJNRD2311005.pdf |
| Downloads: | 000118757 |
| ISSN: |
2456-4184 | IMPACT FACTOR: 8.76 Calculated By Google Scholar| ESTD YEAR: 2016 An International Scholarly Open Access Journal, Peer-Reviewed, Refereed Journal Impact Factor 8.76 Calculate by Google Scholar and Semantic Scholar | AI-Powered Research Tool, Multidisciplinary, Monthly, Multilanguage Journal Indexing in All Major Database & Metadata, Citation Generator |
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Published Paper ID:IJNRD2311005 Registration ID: 207266 Published In: Volume 8 Issue 11, November-2023 DOI (Digital Object Identifier): Page No: a47-a54 Country: warangal, TELANGANA, India Research Area: Engineering Publisher : IJ Publication Published Paper URL : https://www.ijnrd.org/viewpaperforall?paper=IJNRD2311005 Published Paper PDF: https://www.ijnrd.org/papers/IJNRD2311005 |
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ISSN: 2456-4184
Impact Factor: 8.76 and ISSN APPROVED
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