Challenge May-2022

Medical Claim Processing                                                                             Solutions

Claim processing is one of the most popular area where rule engines demonstrate their power. In this challenge we ask you to build a decision service that deals with for a typical claim validation issue related to the International Statistical Classification of Diseases and Related Health Problems known as ICD-10.

This CSV file “ICD10Codes.csv” consists of two columns that represent different diagnoses:

Column 1,Column 2

The actual file contains around 70,000 code combinations. Your claim processing decision service receives a set of claim diagnoses such as {M43.6, F45.8} as its input. By comparing these codes with those found in Column 1 and Column 2, it should validate the claim by producing the errors “Diagnose Code [XXX] cannot be reported together with [YYY, ZZZ, …]” in the following situations:

  1. Diagnose Code [XXX] is found in Column 1 while there are other diagnoses found in Column 2
  2. Diagnose Code [XXX] is found in Column 2 while there are other diagnoses found in Column 1.

Keep in mind that some diagnoses can be found in both columns, and your service should not produce duplicate errors.

Here are several test cases for your service to run:

  1. D47.02,C94.32
  2. E71.313,E72.3
  3. R29.891, M43.6, F45.8
  4. D75.81,C94.42

Please submit your solutions using your favorite BR/DM tools. Your solutions should include the following information:

  • Actually produced error messages for all test cases
  • How your rules are represented
  • How your data is represented
  • Performance results.