Claims Lifecycle Workflow with Graph Database Integration

Run the Claims Lifecycle Workflow with Graph Database Integration MicroSim Fullscreen

About This MicroSim

This flowchart follows a healthcare claim from submission through adjudication to payment, showing where graph-database traversals (green) sharpen each decision. Eligibility, network and coverage, prior authorization, and year-to-date accumulations are all answered by graph queries, and every gate that fails routes the claim to a single denied outcome with a specific reason. The clean path ends by writing the paid claim back into the graph for analytics.

How to Use

Hover over any step to read what it does; green steps are graph-database operations. Follow the right-hand "happy path" down through the adjudication gates to payment, and trace the left-hand edges to see how an invalid format, ineligible member, non-covered service, missing prior authorization, or failed edit each ends in denial.

Iframe Embed Code

You can add this MicroSim to any web page by adding this to your HTML:

<iframe src="https://dmccreary.github.io/modeling-healthcare-data/sims/claims-lifecycle-workflow-graph-database-integration/main.html"
        height="450px"
        width="100%"
        scrolling="no"></iframe>

Lesson Plan

Grade Level

9-12 (High School Geometry)

Duration

10-15 minutes

Prerequisites

TODO: List prerequisites.

Activities

1. Exploration (5 min): TODO
2. Guided Practice (5 min): TODO
3. Assessment (5 min): TODO

Assessment

TODO: List assessment criteria.

References

1. TODO: Add references.