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0111 · Jun 202219922001200920172026
1 result for “upcoding”
Applications of Machine Learning to the Identification of Anomalous ER Claimscs.LG

Two machine learning models detect anomalies in ER claims, saving up to 40% in improper payments.

problem Improper health insurance payments from fraud and upcoding.
method Two machine learning models: an upcoding model based on severity code distributions and a random forest model for claim sorting.
result Random forest model saved 12% to 40% in improper payments compared to a baseline approach.
machine learninghealth insurance claimsanomaly detectionER claimsupcoding
2022-06-16abs ↗pdf ↗