DataRovers – AI Based Healthcare

DataRovers is an Artificial intelligence-based solution to manage and make decisions about insurance-related challenges on the hospital end.

Industry

Healthcare

Artificial Intelligence Service

Azure Artificial Intelligence

Services

Research, Conceptualization, Design, Smart Contract development of Trading/Swapping, Liquidity pool, Wallet and multi-chain contacts relevant to their standard, Development, Mobile Application, Testing, Deployment

Datarovers

Overview

In order to provide the patient’s insurance data to DataRovers, the hospitals install the software provided by OptimusFox called Scrubber. A scrubber is software that scrapes the specific format data (X12 medical standard sheet) from the hospital database and passes it to DataRovers. Then on the DataRovers dashboard, the hospital can enjoy the AI-powered insights of patient data and analytics to track the record. The main functionality of DataRovers is to provide the acceptance and rejection status of patients’ insurance claims to the hospital.

The healthcare claiming procedure has the following roles:

837:

The claim of the hospital to the Insurance Company is called 837.

835:

The reply of the Payer to the hospital claim is called 835. DataRovers is trained by providing the datasets of 835 files for predicting the claim's status.

Get the best AI solutions to insurance-related challenges with DataRovers

Problems and Solutions

Hospital’s Revenue Loss:

One hospital is connected to multiple insurance base companies and it’s not possible for a hospital to send the details of patients’ claims daily to the insurance companies so the hospital proceeds with these claims’ procedure after a month or some time period. However, the insurance companies deny some of these claims received from the hospital causing huge losses for the hospital.
Solution:
OptimusFox built DataRovers as a solution to mitigate the potential risk of unaccepted claims. The hospital can avoid a large amount of loss using DataRovers AI-powered decision-making ability about the acceptance criteria of patients’ claims from the insurance company.

Rejection of Service:

In most cases, the insurance companies update their terms and conditions, and services policy and based on that reject some services. It’s not possible for a hospital to check the terms and conditions of every insurance company regularly which leads to a loss in revenue generated by the hospital.
Solution:
DataRovers supports multiple companies and provides the acceptance criteria for all the services from these insurance companies to mitigate further loss at the hospital end. If the chances for acceptance are low then the hospital can manage it by giving some of the services via the insurance company and for some services it can ask the patient to pay. This reduces the rejection rate of service from the payer.

Features

Confidence in Decision Making

DataRovers provides the data analytics, insights, graphs, and AI-based future predictions for multiple insurance companies that are easy to understand and help the hospital in decision-making on the acceptance and rejection of the patient’s insurance claim. The hospital can also check the detail of rejected drugs by insurance companies on the platform that is automatically rendered from denied claims via the AI-based solution.

277 Acknowledgment

277 is used when the hospital gets no reply (835) from the insurance company and claims status from the payer and to keep track of all the details. A specific module in the name of 277 Ack is offered on DataRovers, where the users can check the 277 status of payers.

Future Revenue Prediction

Other than the weekly, monthly, and yearly predictions about acceptance criteria of the insurance claim for decision making, the DataRovers can also predict the expected revenue of the hospital, the number of patients, and estimated profit in the next year.

Patients’ Claims Insights

DataRovers provides complete insights and an incredible visualization of the data provided by the hospital that helps to understand trends and keep track of all the data.

Technology Stack

OptimusFox implements the best tools and technology stack according to the use case of the Project. For DataRovers, the following technology is entertained:
AZURE MACHINE LEARNING

It is a Microsoft cloud-based service. Multiple azure machine learning services are used for managing and accelerating DataRovers which are given below:

APS.Net
.NET

The technology used for backend development.

sql
SQL

Database for DataRovers.

Post man
Postman

For testing purpose.

Confluence
Confluence

For documentation and record-keeping.

Jira
Jira

For task management between teams.

Visual Studio
Visual Studio Code

IDE used for development in React.

Visual Studio
Visual Studio 2022

IDE used for development in .Net.

React Native
React JS

The language used for frontend development.

Working Flow

DataRovers-infographic
DataRovers-infographic-mobile

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