6 April 2000 Auditing health insurance reimbursement by constructing association rules
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Abstract
Two months of reimbursement claim data of the admission patients from National Taiwan University Hospital have been used to be the training set (200 MB or so), a quick method has been used to find out the association rules among the illness, the examinations and treatments, the drugs, and the equipment. The filtered rules by setting the minimum support and the minimum confidence are used to screen out a month claimed data from the other hospital. Some unproper orders to the patients are able to checked out. In this paper, we will discuss the algorithm for generalizing association rule and the experiments of using the association rules to screen out the unproper orders in the health reimbursement claims.
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I-Jen Chiang, I-Jen Chiang, } "Auditing health insurance reimbursement by constructing association rules", Proc. SPIE 4057, Data Mining and Knowledge Discovery: Theory, Tools, and Technology II, (6 April 2000); doi: 10.1117/12.381725; https://doi.org/10.1117/12.381725
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