Risk management and implementation of a decision-support system for medical controls
The objectives of the National Health Insurance Fund (Caisse nationale d'assurance sociale (CNAM)) are expenditure control and improving the quality of care. Electronic transmission requirements and medical control prerogatives have made it necessary for the CNAM to invest in the automated processing of medical claim forms.
The main objective is the establishment of a decision-support system with a medical knowledge base which would take into account the specificities of each medical claim form.