[DMP 2024]: HCX - Digitizing Insurance Plans: Encoding health insurance products for machine readability

[shiva-rakshith]

Description

This project aims to create tools to digitise insurance plans by converting health insurance product documents into machine-readable formats. Our objective is to enhance accessibility, efficiency, and transparency within the insurance industry. By digitising insurance products we aim to facilitate faster claims adjudication, this initiative will empower both insurance providers and consumers.

Goals

• Create machine readable insurance plans as per the FHIR standards :
  Data Extraction & parsing : Extract and interpret data from health insurance product documents (primarily pdf or docs), including policy details and coverage information.
  Data Standardization and coding : Standardise and code extracted data into structured formats compatible with FHIR standards as prescribed by Open HCX platform, ensuring consistency for interoperability across insurance systems.
  Data Quality Enhancement : Identify and rectify discrepancies in digitised insurance plans, filling missing information and resolving ambiguities for completeness.
• Testing and validation harness for the coded insurance plans :
• Develop the testing and insurance plan validation harness for the digitised insurance plans created by other ecosystem participants.

Expected Outcome

1. Backend required to extract, process, and encode insurance product data.
2. The tool should generate standardised insurance plans with FHIR codes, enabling machine-readable formats for processes like auto adjudication.
3. Test & validate insurance plans against the finalised format.

Acceptance Criteria

Any human readable format such as PDF etc. are converted into FHIR Insurance profiles
https://ig.hcxprotocol.io/v0.7.1/StructureDefinition-HCXInsurancePlan.html

Implementation Details

1. Project requires a detail understanding of JAVA or Python and APIs
2. Setup HAPI FHIR server in local machine
3. Understand FHIR profiles https://ig.hcxprotocol.io/v0.7.1/StructureDefinition-HCXInsurancePlan.html
4. Use programming concepts to convert available insurance plans in PDF format into FHIR structures

Mockups / Wireframes

NA

Product Name

Digitizing Insurance Plans

Project Name

Digitizing Insurance Plans: Encoding health insurance products for machine readability

Organization Name:

Swasthalliance

Domain

Healthcare

Tech Skills Needed:

JAVA, HAPI FHIR, PYTHON

Mentor(s)

@saurabh-singh-17

Complexity

High

Category

Performance Improvement, Feature, PoC

Sub Category

API, Accessibility, Backend, Research

[jaymehta002]

Can i work on this?

[Shelly011s]

@saurabh-singh-17 Hello, I am Shelly Suthar and I am a full stack developer with significant experience in open source. I would love to work on this issue as a part of DMP 2024. Let me know how to reach out to you for further discussions on the proposal for this issue.

[AieshaShetty]

Hi @saurabh-singh-17, I would like to work on this project. My tech stack includes core Java, spring boot, JPA. Is there any smaller issue to work on this first?

[NEGRAH-S]

@shiva-rakshith @saurabh-singh-17 , I am interested to work on this as it completely alligns to my tech stack and use of health API dealing with HL7 standards.

[limarkdcunha]

Hey @shiva-rakshith where can I find an example of doc and corresponding FHIR format for the same. I think we will need NLP as part of this and complexity of the NLP technique will depend on variability of the content in docs or pdf.

[AbhimanyuSamagra]

Do not ask process related questions about how to apply and who to contact in the above ticket. The only questions allowed are about technical aspects of the project itself. If you want help with the process, you can refer instructions listed on Unstop and any further queries can be taken up on our Discord channel titled DMP queries. Here's a Video Tutorial on how to submit a proposal for a project.

[limarkdcunha]

Hey @AbhimanyuSamagra I think my question is fairly technical as I need some inputs and expected outputs based on which I can start looking for appropriate tech stacks and libraries. As this project is kinda niche I will need to dig deep to find good libraries.

[glitcher007]

hii @shiva-rakshith
can we use llm for extracting data from pdfs and other files ?

[saurabh-singh-17]

Hello all,

We request you to prepare a proposal which should include how you would approach the problem and submit your proposal as stated by C4GT guidelines. You can additionally mail the proposal to us.

Thanks,
Saurabh

[pinki639]

hey there @saurabh-singh-17 pinki bhati is this side i want to work on this project I have knowlege of basic and advanced java