Data Mining Case Studies

 

data mining case study

Data Mining Case Study: Data mining is the complicated process which is characterized with the collection and analysis of the unknown data and its transformation into simpler algorithms which are known by the people who do not have mathematical education in order to use this data in various spheres of human life. Data mining is closely connected with computer science and studies the . Executive Summary: Every health plan is intensely focused on the accurate and timely reimbursement to providers for the services delivered to its members. Despite best efforts and investment to avoid errors, CMS reports as much as 10% of claims are paid in error, resulting in hundreds of millions of dollars in excess claim expense. Pre-paymentRead more. Feb 27,  · Data Mining Case Study 1. Sales of Orthopedic Equipment Xiaomeng (Mina) Chai 11/25/ 2. Client’s Background • Client: a large manufacturer of orthopedic equipment in the United States • Customer base: almost all hospitals over the 50 states.


Claim Analytics Case Study: Data Mining - Equian


Executive Summary: Every health plan is intensely focused on the accurate and timely reimbursement to providers for the services delivered to its members. Pre-payment edit rules are established to avoid errors and post-payment overpayment identification programs are put in place to recover lost revenue, yet leakage still occurs.

A review of their medical claim reimbursement accuracy was conducted including adjudication errors, billing and coding errors, data mining case study, overpayment identification, recovery and process improvement opportunities. Five factors were impacting their review and analysis. Firstdata mining case study, the plan had limited visibility into their results and no clear benchmarks for overpayment recovery had been established.

Seconda highly-sensitive network management department was concerned that undue friction from more or additional overpayment recovery would negatively affect provider relations. Thirdthere was limited budget dollars for both technology investment and additional resources to identify and recover overpayments. Fourththe plan had an existing data mining vendor and no way of knowing if anything was being missed.

Fifththe strategic direction was to focus on cost avoidance and accuracy vs. It was time for another approach and a different perspective. Equian addressed several issues that data mining case study plan faced. Existing claim and data extracts were utilized data mining case study reimbursement analysis and overpayment identification. Equian auditors conducted validations of suspected errors and categorization of error types—the first step in root cause and corrective action development.

Validated overpayments were pursued for recovery, and insights were gathered related to the cause. The result was a significant reduction in overpayment errors, successful identification and implementation of numerous cost avoidance opportunities, and higher overall reimbursement accuracy that further reduced administrative expenses, data mining case study. This hospital generated 1, observation bills during a 12 Read more. Background: The Enrollment Services division of an Equian client launched an initiative to enhance their existing processes for soliciting, obtaining and updating COB information within their systems.

At that time, the client required completion of Read more. They were utilizing outside law firms for some of their Read more. Background: A leading healthcare provider was looking to maintain their internal subrogation unit of 8 while improving the management and efficiency of their subrogation process.

Some files were being managed by the internal unit while Read more. Subscribe to Equian News. Next Previous. Equian More posts by Equian. Related Post. By Equian Comments are Closed.

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Data Mining | Case Study Template

 

data mining case study

 

R and Data Mining: Examples and Case Studies and millions of other books are available for Amazon Kindle. Learn more Enter your mobile number or email address below and we'll send you a link to download the free Kindle wilrdmanssa.gq by: Executive Summary: Every health plan is intensely focused on the accurate and timely reimbursement to providers for the services delivered to its members. Despite best efforts and investment to avoid errors, CMS reports as much as 10% of claims are paid in error, resulting in hundreds of millions of dollars in excess claim expense. Pre-paymentRead more. International Workshop on Data Mining Case Studies and Practice Prize. Recognizing outstanding practical contributions in the field of data mining. Workshop is held each year at IEEE or ACM KDD conference on data wilrdmanssa.gq date: 08 Dec,