一个多模块的AI. 智能医疗保险支持系统使用检索增强代
Sejal Hanmante1, Shivani Patil1, Aniket K Shahade2
1Symbiosis Institute of Technology, Pune Campus, Symbiosis International (Deemed University), Pune, India.
Scientific reports
|December 4, 2025
概括
这项研究引入了一个统一的AI系统,使用检索增强生成 (RAG) 进行医疗保险查询,政策建议和文档检索. 人工智能评估器确保响应质量,提高透明度和用户支持.
科学领域:
- 人工智能的人工智能
- 医疗保险信息学 医疗保险信息学
- 自然语言处理自然语言处理.
背景情况:
- 与医疗保险信息的互动是复杂的.
- 现有的AI解决方案通常单独解决对话辅助,政策建议和文档检索问题.
- 需要采用统一的方法来简化用户与医疗保险数据的互动.
研究的目的:
- 为医疗保险信息开发基于检索增强生成 (RAG) 的多模块人工智能系统.
- 将对话式人工智能,政策建议和文档检索集成到一个单一的架构中.
- 引入人工智能评估代理,用于响应的自动化质量评估.
主要方法:
- 开发了一个统一的AI系统,集成聊天机器人,RAG驱动的政策推器和条款级文档检索.
- 用于推引擎的结构化和非结构化政策数据.
- 实施了一个评估代理来评估响应质量 (相关性,准确性,清晰性,有用性).
主要成果:
- 取得了强大的语义检索性能 (BERTScore F1高达0.84).
- 证明了强大的政策建议 (击中@5 = 1.0,回忆@5 = 0.833).
- 从政策文件中展示了有效的条款检索 (BERTScore F1 = 0.8443).
结论:
- 拟议的基于RAG的模块化AI系统有效地简化了医疗保险互动.
- 包括一种质量评估剂可以减少幻觉,提高透明度.
- 这种方法在医疗保险领域提供了增强的,以用户为中心的支持.
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