1. UM LEVANTAMENTO SOBRE O USO DE ALGORITMOS DE APRENDIZADO DE MÁQUINA EM AUDITORIAS DE PLANOS DE SAÚDE.
- Author
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Carlo Raduenz, Jean and da Rocha Fernandes, Anita Maria
- Subjects
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MEDICAL personnel , *MEDICAL audit , *HEALTH insurance , *MACHINE learning , *AUDITORS - Abstract
Although health care providers have more than 47 million health insurance clients in Brazil, these companies still have processes that are manual. One of these processes is that of the medical audit that performs the analysis of each account with expenses that were incurred by the operator's beneficiary in any hospital, clinic or laboratory. Each account is reviewed to make sure that there is nothing outside the context of a surgery, examination or consultation. The costs of these audits are high and the outcome is varied and according to the auditor's individual knowledge. In addition to being a lengthy process, these bills will only be paid to those who provided the service after the auditors' review which brings dissatisfaction to those awaiting payment. Manual execution of this process is susceptible to failure and fraud. In this context, Machine Learning algorithms are used to assist in the audit process in various areas of knowledge. Thus, this paper presents a survey on the application of Machine Learning algorithms in medical audits, analyzing which algorithms are most used. [ABSTRACT FROM AUTHOR]
- Published
- 2020
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