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Title |
Minimum Data Set (MDS) in Saudi Arabia's Medical Claims Insurance |
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Author |
Bashaier Al-Hamad, Noor Al-Dossary, Hayfa Al-Muhaisen, Mohammed Gollapalli, Atta Rahman, Mohammed Salih Ahmed |
| Citation |
Vol. 25 No. 2 pp. 50-60 |
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Abstract |
The denial of medical claims presents a critical challenge within the healthcare sector, as insurance providers decline to cover the expenses associated with providing medical assistance to policyholders in hospitals or other healthcare facilities. Claim denials often arise due to missing or inaccurate information, serving as a justification for the refusal of coverage. This research aims to explore the potential of technology in reducing the likelihood of claim denials by enabling the creation of accurate data. By implementing standardized procedures for data gathering and validation, organizations can ensure the collection and recording of necessary data, thereby enhancing data quality, reliability, customer satisfaction, operational effectiveness, and facilitating risk assessment and pricing strategies. The research community has put a lot of effort into this pertinent area, but more work is still required. There are many approaches to increase the accuracy and quality of data used in healthcare. One of these technologies is called Minimum Data Set (MDS), and it acts as a thorough database for health insurance. This method was employed in Saudi Arabia, aligning with the broader objectives outlined in Vision 2030. It gathers and assesses data related to health insurance claims, healthcare providers, beneficiaries, and the services they receive. This research study makes a valuable contribution to the existing body of knowledge by utilizing advanced data manipulation techniques on a unique dataset that has not been previously utilized for research purposes. The primary objective of this research is to maximize the potential of the MDS dataset through data manipulation. The dataset was cleaned and prepared using R Studio. A retrospective analysis was conducted to identify trends, evaluate performance, and provide insights into future decision-making. Managing research outcomes in the early stages can provide valuable insights into the context of historical data, enabling insurance companies to make more informed decisions about the future. Moreover, the researchers in this field can take this as a pilot study to lever their research journey. |
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Keywords |
Claim Denials, Healthcare Sector, Saudi Arabia, MDS, Insurance Company, Saudi Arabia, data wrangling. |
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