OMB Individually Reported
Medical Claims Adjudication
High riskExact public inventory row
Description
Uses Quantum Choice (QC) to adjudicate medical claims and analyze the data within the system.
Detailed example
Medical Billing Payment decisions are made utilizing the AI.
AI / analytics pattern
Classical/Predictive Machine Learning: Models trained on data to make predictions or classifications based on identified patterns or relationships.
Automation level / stage
c) Deployed – The use case is being actively authorized or utilized to support the functions or mission of an agency.
Expected benefit
Cost savings and ensure compliance with billing regulations and contract pricing terms. It also provides data analysis to assist with the FBOP's mission.
Controls / human review
ATO: No; PIA: Not published
Data needed
The case owner relied on DOJ AI governance practices to select and prepare data, as well as evaluate performance.