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