AnExplainable AI Engineering Framework for Claims-Only First-Stage Provider Audit Triage Using SHAP-Guided Hybrid Retrieval-Augmented Generation
This study proposes an explainable artificial intelligence (XAI) engineering workflow for provider-level healthcare claim audit prioritization using SHAP-guided hybrid retrieval-augmented generation (RAG). The framework integrates provider-level claim aggregation, tree-based risk screening, SHAP explanation, explorator...
Danni Huang, Litong Song, Yue Chen et al.
· Machine Learning and Knowled... · 0 citations