Medical error detection based on insurance claims

Huanmei Wu, Adam Jones, Ekta Agrawal

Research output: Chapter in Book/Report/Conference proceedingConference contribution

Abstract

The administrative health claim data collected by insurance companies often contain versatile information on individual patients, such as their interaction with doctors, medical labs, pharmacies, and other health care facilities. Since all the information for a patient is gathered in one place this is an excellent source to identify potential medical errors from multiple sources of services. Once identified, the errors can be verified. If necessary, the potential errors will be forwarded to the associated physicians. An application prototype of an administrative medical error detection and prevention had been created. The system is tested and validated by examples to detect medical errors through the creation of a list of medical error rules. Experimental results showed that medical errors can be identified using the insurance claim database. This is an inexpensive way for identifying and preventing medical errors, which will provide benefits to patients, providers and payers.

Original languageEnglish (US)
Title of host publicationHEALTHINF 2011 - Proceedings of the International Conference on Health Informatics
Pages604-607
Number of pages4
StatePublished - Jul 15 2011
EventInternational Conference on Health Informatics, HEALTHINF 2011 - Rome, Italy
Duration: Jan 26 2011Jan 29 2011

Publication series

NameHEALTHINF 2011 - Proceedings of the International Conference on Health Informatics

Other

OtherInternational Conference on Health Informatics, HEALTHINF 2011
CountryItaly
CityRome
Period1/26/111/29/11

Keywords

  • Insurance claim data
  • Medical error detection

ASJC Scopus subject areas

  • Health Informatics
  • Health Information Management

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  • Cite this

    Wu, H., Jones, A., & Agrawal, E. (2011). Medical error detection based on insurance claims. In HEALTHINF 2011 - Proceedings of the International Conference on Health Informatics (pp. 604-607). (HEALTHINF 2011 - Proceedings of the International Conference on Health Informatics).