Methods: The algorithm used a single payer’s Medicaid medical and pharmacy claims (August 1, 2009, to July 31, 2014) for patients with schizophrenia (N = 12,353) to predict those at high risk for ...

We developed two algorithms to identify patients with stomach, lung, colorectal, breast, and cervical cancers: diagnosis only (algorithm 1), and combining diagnosis, treatments, and medicines ...

Categorizing patients with cancer by their disease stage can be an important tool when conducting administrative claims-based studies. As claims databases frequently do not capture this information, ...

The nation’s largest health insurance company pressured its medical staff to cut off payments for seriously ill patients in lockstep with a computer algorithm’s calculations, denying rehabilitation ...

The software system allows claim rejections without doctors ever opening patient medical records, according to the lawsuit. Cigna, the healthcare and insurance giant, was hit with a lawsuit on Monday ...

Federal data shows that health insurance companies denied more than 49 millions claims in 2021, but customers appealed less than 0.2 percent of them. Investigative journalists at ProPublica found that ...