A SYSTEM AND METHOD PROVIDING ARTIFICIAL INTELLIGENCE-BASED CLINICAL DOCUMENTATION, CODING, AND COMPLIANCE DECISION SUPPORT WITHIN A HEALTHCARE PROVIDER INFORMATION PROCESSING AND MANAGEMENT SYSTEM ENVIRONMENT.

Abstract

The invention relates to a system and a computer-implemented method that provides AI-based clinical documentation, coding, and compliance decision support in a healthcare provider information processing and management system (1). The system comprises a data acquisition module (2) that receives structured clinical data, an AI processing module (5) that evaluates the data and generates clinical documentation and code recommendations, a compliance and audit module (9) that checks the generated output on a rule graph derived from the contract and rule documents of the relevant contracting institution and ensures that only the checked output is transmitted, and an output distribution module (7) that submits the output for approval by healthcare personnel. The modules form an integrated architecture independent of the type of system and the provider of the AI ​​model. Information processing is carried out without human intervention; the final decision rests with the healthcare personnel.