Findings from University of Paris Reveals New Findings on Artificial Intelligence (Responsible Artificial Intelligence In Healthcare: Predicting and Preventing Insurance Claim Denials for Economic and Social Wellbeing): Artificial Intelligence

2024 FEB 21 (NewsRx) -- By a News Reporter-Staff News Editor at Insurance Daily News -- Investigators discuss new findings in Artificial Intelligence. According to news reporting from Nanterre, France, by NewsRx journalists, research stated, “It is estimated that one out of seven health insurance claims is rejected in the US; hospitals across the country lose approximately $262 billion annually due to denied claims. This widespread problem causes huge cash-flow issues and overburdens patients.”

The news correspondents obtained a quote from the research from the University of Paris, “Thus, preventing claim denials before claims are submitted to insurers improves profitability, accelerates the revenue cycle, and supports patients’ wellbeing. This study utilizes Design Science Research (DSR) paradigm and develops a Responsible Artificial Intelligence (RAI) solution helping hospital administrators identify potentially denied claims. Guided by five principles, this framework utilizes six AI algorithms - classified as white-box and glass-box - and employs cross-validation to tune hyperparameters and determine the best model. The results show that a white-box algorithm (AdaBoost) model yields an AUC rate of 0.83, outperforming all other models.”

According to the news reporters, the research concluded: “This research’s primary implications are to (1) help providers reduce operational costs and increase the efficiency of insurance claim processes (2) help patients focus on their recovery instead of dealing with appealing claims.”

This research has been peer-reviewed.

For more information on this research see: Responsible Artificial Intelligence In Healthcare: Predicting and Preventing Insurance Claim Denials for Economic and Social Wellbeing. Information Systems Frontiers, 2023;25(6):2179-2195. Information Systems Frontiers can be contacted at: Springer, Van Godewijckstraat 30, 3311 Gz Dordrecht, Netherlands. (Springer - www.springer.com; Information Systems Frontiers - http://www.springerlink.com/content/1387-3326/)

Our news journalists report that additional information may be obtained by contacting Antoine Harfouche, University of Paris, Segmi, Ceros, Nanterre, France. Additional authors for this research include Marina Johnson and Abdullah Albizri.

The direct object identifier (DOI) for that additional information is: https://doi.org/10.1007/s10796-021-10137-5. This DOI is a link to an online electronic document that is either free or for purchase, and can be your direct source for a journal article and its citation.

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