To collect the necessary information for review and reduce the manual work of professional review physicians for searching information, NHIA utilizes the big date to analyze the key points for professional review via system prompt.

Professional Review System Prompt

    Take the case of medical expenses for example, the system presents information such as whether the insurance medical service is the target of audit testing for screening index and the reasons behind screening index, statistics of medical uses and the record of reimbursement in the insurance medical service. Furthermore, take pre-review case for instance, the system presents information such as medications for cancer immunotherapy shall not be combined with those for targeted therapy, immunotherapeutic medications for rheumatoid arthritis not suitable for individuals, medication procedure for rheumatic disease and examination results. The efforts are all aimed at helping physicians quickly grasp the main points of professional review and simply the manual work of looking up medical record and payment guidelines.

AI assisted precision review

    NHIA utilizes big data and AI assisted technology to organize structured expense report and unstructured examination image and report. Under the premise of respecting medical profession, NHIA develops the mechanism for AI assisted precision reviewing.

Case sharing: Quality monitoring of uploaded images or report prior to declaration from contracted medical institutions

    NHIA encourages contracted medical institutions to upload medical images and examine the report and results in real time. In terms of examination report of CT and MRI, Hepatitis C and kidney function, the NHIA has established the quality monitoring system, which helps understands whether the quality of information uploaded by medical institutions is stable. For instance, the system examines whether the information of images are consistence with those of the uploaded physical order items, whether the report includes the findings from images or certain presumptions, whether the examination result is null. The monitoring result thus serves to remind the medical institutions of the quality of uploaded information in an appropriate manner, increase the value of NHI database and improve the sharing efficiency of cloud system.