MediConCen MediConCen FWA ML Engine
CLM-2026-003847 INPATIENT RED · HIGH RISK
Chan Wei Ming · City Medical Centre · HK$84,200 · J18.9 Pneumonia
Ensemble Risk Assessment — All models applied to this claim
87
/ 100
RED
AI-Synthesised Risk Summary
Model-by-Model Results 5 models · 3 RED · 1 AMBER · 1 GREEN
ModelTypeScoreRAGKey DriversAction
Explainability & Auditability — The factors that drove the AI decision, in plain language
Key Drivers — Why This Claim Is Flagged
Positive bars push risk score higher; negative bars push it lower.
Decision Audit Trail AUDIT-READY
Model Performance — Live production metrics · FraudNet-Inpatient v3.2
Precision
91.4%
↑ +1.2% MoM
Recall
88.7%
↑ +0.8% MoM
FP Rate
4.2%
↓ −0.5% MoM
STP Rate
73.1%
Auto-approved
Model Drift (PSI)
0.041
⚠ Watch
Precision / Recall Trend
Model Drift Monitor (PSI) 0.041 — WATCH
ICD / Procedure-level Risk Drivers Drill-down from ensemble score
Peer Benchmark Comparison
Model Lifecycle & Governance — New model activation · drift management · backtest
New Model Activation — FraudNet-Inpatient v3.3
Complete governance steps to promote to production
STEP 3 OF 5
Each step requires sign-off from the Model Risk Officer before proceeding.
Existing Model Drift Monitoring
Historical Back Test
Compare before/after parameter update on historical claim data
NOT RUN
Back testing uses anonymised historical data — no live claims affected.