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Description:

openimisbeclaimaiquality 2.0.0

openIMIS Backend Claim AI Quality reference module
This repository holds the files of the openIMIS Backend Claim AI Quality reference module.
It is dedicated to be deployed as a module of openimis-be_py.

ORM mapping:
None
Listened Django Signals
SubmitClaimsMutation
Adds 'claim_ai_quality' key to the json_ext field on claim submissions.
If ClaimAiQualityConfig.event_based_activation is set to true AI adjudication is performed.
EvaluateByAIMutation
Adjudication is called using after_claim_ai_evaluation_validation signal.
Services

AiQualityReportService, loading claims used for misclassification report

Reports

miscategorisation_report

GraphQL Queries
None
GraphQL Mutations
EvaluateByAIMutation
Used for manual AI Adjudication of selected claims through after_claim_ai_evaluation_validation signal.
gql_mutation_submit_claims_perms permission required.
Additional Endpoints

miscategorisation_report: generating report regarding ai misclassification in PDF format

Reports

miscategorisation_report: AI Evaluation accurracy and list of misclassified claims

Configuration options (can be changed via core.ModuleConfiguration)
Rest API Configuration

rest_api_login_endpoint: Endpoint used for getting user authentication token.
Default: http://localhost:8000/api/api_fhir_r4/login/,
rest_api_bundle_evaluation_endpoint: Endpoint used for sending bundle of claims for evaluation.
Default: http://localhost:8000/api/claim_ai/claim_bundle_evaluation/,
rest_api_single_claim_evaluation_endpoint: Endpoint used for sending single claim for evaluation.
Default: http://localhost:8000/api/claim_ai/claim_evaluation/,
wait_for_evaluation: If set to False system doesn't wait for server response and have to use other method to
pull adjudication data.
rest_api_user_login: Username of user used for AI Server JWT Authentication.
rest_api_user_password: Username of user used for AI Server JWT Authentication.

Remaining

claim_ai_username: User dedicated to perform DB operations executed in background by Claim AI Quality module.
By default it's _ClaimAIAdmin added in module migration.
event_based_activation: Determines if AI evaluation should be done on claim submission (True) or
using scheduled job (True). Default: False
bundle_size: number of claims in one bundle if scheduled job is used. Default: 200,
accepted_category_code: Code for Items/Services positively evaluated by AI. Default: 0,
rejected_category_code: Code for Items/Services negatively evaluated by AI. Default: 1,
reason_rejected_by_ai_code: FHIR Rejection reason code for claims rejected by AI. Default: -2,
date_format: date format used in FHIR response. Default: %Y-%m-%d,
misclassification_report_perms: List of permissions required to get Misclassification report.
Default: [112001],
evaluation_method: Method used for AI evaluation. If set to rest_api claims are adjudicated using
REST API connection. If set to integrated then system is using claim_ai module installed on same instance
as Claim AI Quality server.
Default: (empty string). - if claim_ai module is installed locally it uses this module. If it's
not installed REST API is used.

openIMIS Modules Dependencies

core
claim
api_fhir_r4
location
report