scholarly journals Validation of diagnosis codes to identify hospitalized COVID ‐19 patients in health care claims data

2021 ◽  
Author(s):  
Sheryl A. Kluberg ◽  
Laura Hou ◽  
Sarah K. Dutcher ◽  
Monisha Billings ◽  
Brian Kit ◽  
...  
Keyword(s):  
Health Care ◽  
Claims Data ◽  
Diagnosis Codes ◽  
Health Care Claims

scholarly journals Health Care Utilization and Direct Costs Among Patients Diagnosed with Cluster Headache in U.S. Health Care Claims Data

2018 ◽  
Vol 24 (9) ◽  
pp. 921-928 ◽  
Author(s):  
Casey K. Choong ◽  
Janet H. Ford ◽  
Allen W. Nyhuis ◽  
Rebecca L. Robinson ◽  
Sheena K. Aurora
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Cluster Headache ◽  
Claims Data ◽  
Direct Costs ◽  
Care Utilization ◽  
Health Care Claims

Lymph node biopsy utilization in lymphoma: Analysis of U.S. commercial health care claims data.

2014 ◽  
Vol 32 (15_suppl) ◽  
pp. e17643-e17643
Author(s):  
Benjamin Chastek ◽  
Stacey DaCosta Byfield ◽  
Carolyn Bodnar
Keyword(s):  
Health Care ◽  
Lymph Node ◽  
Claims Data ◽  
Lymph Node Biopsy ◽  
Node Biopsy ◽  
Health Care Claims

scholarly journals Real World Evidence in Mainland China: Experience with the Use of Health Care Claims Data

2014 ◽  
Vol 17 (7) ◽  
pp. A728 ◽  
Author(s):  
Y. Yang ◽  
J. Zhang ◽  
F. Du ◽  
W. Montgomery ◽  
H. Li ◽  
...  
Keyword(s):  
Health Care ◽  
Real World ◽  
Claims Data ◽  
Mainland China ◽  
Real World Evidence ◽  
Health Care Claims ◽  
Use Of Health Care

Identification of abacavir hypersensitivity reaction in health care claims data

2007 ◽  
Vol 16 (3) ◽  
pp. 289-296 ◽  
Author(s):  
Beth L. Nordstrom ◽  
Heather S. Norman ◽  
Timothy J. Dube ◽  
Marsha A. Wilcox ◽  
Alexander M. Walker
Keyword(s):  
Health Care ◽  
Hypersensitivity Reaction ◽  
Claims Data ◽  
Health Care Claims

scholarly journals Combating Health Care Fraud and Abuse: Conceptualization and Prototyping Study of a Blockchain Antifraud Framework

10.2196/18623 ◽  
2020 ◽  
Vol 22 (9) ◽  
pp. e18623
Author(s):  
Tim Ken Mackey ◽  
Ken Miyachi ◽  
Danny Fung ◽  
Samson Qian ◽  
James Short
Keyword(s):  
Health Care ◽  
User Interface ◽  
Data Storage ◽  
Claims Data ◽  
Health Care Fraud ◽  
Blockchain Technology ◽  
Smart Contract ◽  
Secure Data ◽  
Health Care Claims ◽  
Technical Framework

Background An estimated US $2.6 billion loss is attributed to health care fraud and abuse. With traditional health care claims verification and reimbursement, the health care provider submits a claim after rendering services to a patient, which is then verified and reimbursed by the payer. However, this process leaves out a critical stakeholder: the patient for whom the services are actually rendered. This lack of patient participation introduces a risk of fraud and abuse. Blockchain technology enables secure data management with transparency, which could mitigate this risk of health care fraud and abuse. Objective The aim of this study is to develop a framework using blockchain to record claims data and transactions in an immutable format and to enable the patient to act as a validating node to help detect and prevent health care fraud and abuse. Methods We developed a health care fraud and abuse blockchain technical framework and prototype using key blockchain tools and application layers including consensus algorithms, smart contracts, tokens, and governance based on digital identity on the Ethereum platform (Ethereum Foundation). Results Our technical framework maps to the claims adjudication process and focuses on Medicare claims, with the US Centers for Medicare and Medicaid Services (CMS) as the central authority. A prototype of the framework system was developed using the blockchain platform Ethereum (Ethereum Foundation), with its design features, workflow, smart contract functions, system architecture, and software implementation outlined. The software stack used to build the system consisted of a front-end user interface framework, a back-end processing server, and a blockchain network. React was used for the user interface framework, and NodeJS and an Express server were used for the back-end processing server; Solidity was the smart contract language used to interact with a local Ethereum blockchain network. Conclusions The proposed framework and the initial prototype have the potential to improve the health care claims process by using blockchain technology for secure data storage and consensus mechanisms, which make the claims adjudication process more patient-centric for the purposes of identifying and preventing health care fraud and abuse. Future work will focus on the use of synthetic or historic CMS claims data to assess the real-world viability of the framework.

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