MedOpt (Medical Benefit Optimizer)

MedOpt Medical Benefit Optimizer

  • Provides web-based portal for automation of healthcare services
  • Provides real time visual and predictive analytics for healthcare systems
  • Provides detection of anomalies and fraud in each transaction using Al engine

An artificial intelligence (Al) enabled medical benefit optimizer system that provides, real-time advance visual and predictive analytics of providers and patient financial data. It automatically generates, alarm on digital suspicious transactions. Knowledge extraction from data has always proven significant to organizations, also, detection of fraudulent cases has always remained a challenge for health insurance companies/governments. Heathcare prgrams have to bear significant financial losses due to fraud cases. MedOpt provides real-time business intelligence to manage resources efficiently resulting in siginificantly easier decision-making process. It provides patients a platform to approach better healthcare services. This software also facilitates healthcare support systems in detection and prevention of fraud.


Features

  • Provides search interface
  • Dashboards consist of Patient, Doctor and Services specific analytics
  • FHIR HL7 compliant registration portal for Providers and Patients
  • Electronic Medical Record (EMR) based system for Patient data acquisition

Main Focus

  • Fraud, waste and abuse have created prominent cost overruns
  • Framework proposed for detecting fraudulent insurance claims
  • Time series traces of every transaction
  • Evaluation is done on local hospital transactional data

Different types of anomalies are detected

Age based, Service availing patterns, Service providing patterns, Gender based