Using AI/ML for Prescriptions Claims Analysis for Major Health Solutions Provider

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Case Study: AI/ML Solutions

Using AI/ML for Prescriptions Claims Analysis for Major Health Solutions Provider

SUMMARY

A major health solutions provider needed a practical way to identify and test more than 10,000 new scenarios. Spearhead Technology implemented AI/ML solutions to automate the testing process and ensure no scenario type is productionized without passing the testing requirements.

Challenges

  • Client has no practical way to identify and test more than 10000 new scenarios
  • Running through its claims primary production system on a day-to-day basis then comparing with regression releases daily

Solutions Offered

  • The AI/ML solution generates all possible claims scenarios (over a hundred million possible combinations) from auto-discovery of claims data objects generated by various development teams.
  • The solution also identifies a statistically random representative sample drawn from the discovered scenarios’ population for regression testing.
  • The solution automates the testing process and ensures that no scenario type is productionized without passing the testing requirements.