Using machine learning to support healthcare professionals in making preauthorisation decisions.
Journal:
International journal of medical informatics
Published Date:
Jun 16, 2016
Abstract
BACKGROUND: Preauthorisation is a control mechanism that is used by Health Insurance Providers (HIPs) to minimise wastage of resources through the denial of the procedures that were unduly requested. However, an efficient preauthorisation process requires the round-the-clock presence of a preauthorisation reviewer, which increases the operating expenses of the HIP. In this context, the aim of this study was to learn the preauthorisation process using the dental set from an existing database of a non-profit HIP.