Browse > Article
http://dx.doi.org/10.22937/IJCSNS.2022.22.2.53

Modelling Data Flow in Smart Claim Processing Using Time Invariant Petri Net with Fixed Input Data  

Amponsah, Anokye Acheampong (University of Energy and Natural Resources, Department of Computer Science and Informatics)
Adekoya, Adebayo Felix (University of Energy and Natural Resources, Department of Computer Science and Informatics)
Weyori, Benjamin Asubam (University of Energy and Natural Resources, Department of Computer Science and Informatics)
Publication Information
International Journal of Computer Science & Network Security / v.22, no.2, 2022 , pp. 413-423 More about this Journal
Abstract
The NHIS provides free or highly subsidized healthcare to all people by providing financial fortification. However, the financial sustainability of the scheme is threatened by numerous factors. Therefore, this work sought to provide a solution to process claims intelligently. The provided Petri net model demonstrated successful data flow among the various participant. For efficiency, scalability, and performance two main subsystems were modelled and integrated - data input and claims processing subsystems. We provided smart claims processing algorithm that has a simple and efficient error detection method. The complexity of the main algorithm is good but that of the error detection is excellent when compared to literature. Performance indicates that the model output is reachable from input and the token delivery rate is promising.
Keywords
HIS; Petri net; claim processing; reachability; data flow;
Citations & Related Records
연도 인용수 순위
  • Reference
1 Dixon, J., Tenkorang, E. Y., and Luginaah, I.: Ghana's National Health Insurance Scheme: a national level investigation of members' perceptions of service provision. BMC International Health and Human Rights, 13(1), 1-10 (2013).   DOI
2 Preker, A. S., Lindner, M. E., Chernichovsky, D., and Schellekens, O. P.: Scaling up affordable health insurance: staying the course. World Bank Publications, (Eds.) p 24 (2013)..
3 United Nations.: Full Report of the Open Working Group of the General on Sustainable Development Goals. Document number: A/68/970. 2014. http://undocs.org/A/68/970. Accessed 2 November 2021.
4 The World Health Organization.: Universal Health Coverage. 2021. https://www.who.int/health-topics/universal-health-coverage#tab=tab_1accessed 2 November 2021.
5 Abiiro, G. A. and McIntyre, D.: Universal financial protection through National Health Insurance: a stakeholder analysis of the proposed one-time premium payment policy in Ghana. Health policy and planning, 28(3), 263-278 (2013).   DOI
6 Pizer, W. A., and Sexton, S.: The distributional impacts of energy taxes. Review of Environmental Economics and Policy, volume 13, issue 1, pp. 104-123 (2020). doi: 10.1093/reep/rey021   DOI
7 Wang, H., Otoo, N., and Dsane-Selby, L.: Ghana National Health Insurance Scheme: improving financial sustainability based on expenditure review. The World Bank (2017)..
8 Du, S., Wu, P., Wu, G., Yao, C., and Zhang, L.: The collaborative system workflow management of industrial design based on hierarchical colored petri-net. IEEE Access, 6, 27383-27391 (2018).   DOI
9 Kaid, H., Al-Ahmari, A., Nasr, E. A., Al-Shayea, A., Kamrani, A. K., Noman, M. A., and Mahmoud, H. A.: Petri net model based on neural network for deadlock control and fault detection and treatment in automated manufacturing systems. IEEE Access, 8, 103219-103235(2020).   DOI
10 Alhassan, R. K., Nketiah-Amponsah, E., and Arhinful, D. K.: A review of the National Health Insurance Scheme in Ghana: what are the sustainability threats and prospects? PloS one, 11(11) (2016), e0165151.   DOI
11 Li, X. Y., Liu, Y., Lin, Y. H., Xiao, L. H., Zio, E., and Kang, R.: A generalized petri net-based modeling framework for service reliability evaluation and management of cloud data centers. Reliability Engineering & System Safety, 207, 107381 (2021).   DOI
12 Hsieh, F. S.: A hybrid and scalable multi-agent approach for patient scheduling based on Petri net models. Applied Intelligence, 47(4), 1068- 1086 (2017).   DOI
13 Liu, C., Zeng, Q., Duan, H., Wang, L., Tan, J., Ren, C., and Yu, W.: Petri net based data-flow error detection and correction strategy for business processes. IEEE Access, 8, 43265-43276 (2020)..   DOI
14 Williams III, R. C., Gordon, H., Burtraw, D., Carbone, J. C., and Morgenstern, R. D.: The initial incidence of a carbon tax across income groups. National Tax Journal, 68(1), 195-213 (2015).   DOI
15 Teixeira, M., Lima, R., Oliveira, C., and Maciel, P.: Performance evaluation of service-oriented architecture through stochastic petri nets. In 2009 IEEE International Conference on Systems, Man and Cybernetics, pp. 2831-2836 (2009). IEEE.
16 Dake, F. A.: Examining equity in health insurance coverage: an analysis of Ghana's National Health Insurance Scheme. 10 (2018).
17 Ling, S., and Schmidt, H.: Time Petri nets for workflow modelling and analysis. In Smc 2000 conference proceedings. 2000 ieee international conference on systems, man and cybernetics.'cybernetics evolving to systems, humans, organizations, and their complex interactions'(cat. no. 0 (Vol. 4, pp. 3039-3044) (2000). IEEE.
18 Shailesh, T., Nayak, A., and Prasad, D.: An UML based performance evaluation of real-time systems using timed Petri net. Computers, 9(4), 94 (2020).   DOI
19 Babu, K. R., and Samuel, P.: Petri net model for resource scheduling with auto scaling in elastic cloud. International Journal of Networking and Virtual Organisations, 22(4), 462-477 (2020).   DOI
20 Santana, J. A. D., Orozco, J. L., Lantigua, D. F., Furka, D., Furka, S., and Cruz, A. G.: Using integrated Bayesian-Petri Net method for individual impact assessment of domino effect accidents. Journal of Cleaner Production, 294, 126236 (2021).   DOI
21 Li, J., Fan, Y., and Zhou, M.: Timing constraint workflow nets for workflow analysis. IEEE Transactions on Systems, Man, and Cybernetics-Part A: Systems and Humans, 33(2), 179-193 (2003).   DOI