openimis-be-claim-ai-quality 2.0.0

The openIMIS Backend Claim AI Quality reference module.

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