Azure Cosmos DB & Azure OpenAI Service Reference Architecture: Medical Claims Management Hackathon

Contoso Insurance manages medical insurance claims through a custom-built application. The application is built on a legacy platform that is difficult to maintain and is not scalable. They want to modernize their application and move it to the cloud. They have decided to use Azure Cosmos DB as the database for their new application. They have also decided to use Azure OpenAI Service to help with the claims management process. They have asked you to help them build a proof of concept (POC) for their new application.

Currently, Contoso has a very tedious process for managing and processing claims. This process involves an extensive amount of human interaction and, therefore, clerical errors are imminent. The manual nature of the process, including the relatively high amount of issues that arise from data introduced by human entry alone, adds unnecessary costs to the company. These costs are realized in the inputting and the processing of the claim. Contoso is seeking help as they search for a better way to process claims.

Contoso would like to build a pilot atop of a version of their current claims submission solution to experiment with various tools in Azure for improving and optimizing operations around claims submission and processing. Ideally, Contoso would like to be able to accomplish the following with the proposed solution:

Reduce the amount of time it takes to process a claim
Implement business rules to automatically approve or deny claims
Run their application at a global scale, enabling them to ingest high volumes of medical claims and apply automated processing logic
Add a layer of intelligence to their application to help with the claims management process by providing an adjudicator with AI generated guidance on what action to take

Their long-term goal after accomplishing the above, which lays the ground work for automated decisions, is to harness AI to automatically review, approve, deny or forward the claim to a manager, replacing the hardcoded rule logic used by the solution.

Prerequisites

Azure Subscription
Subscription access to Azure OpenAI service. Start here to Request Access to Azure OpenAI Service
Backend (Web API, Worker Service, Console Apps, etc.)
- Visual Studio 2022 17.6 or later (required for passthrough Visual Studio authentication for the Docker container)
- .NET 7 SDK
- Docker Desktop (with WSL for Windows machines)
- Azure CLI (v2.49.0 or greater)
- Helm 3.11.1 or greater
Frontend (React web app)
- Visual Studio Code
- Ensure you have the latest version of NPM and node.js:
  - Install NVM from https://github.com/coreybutler/nvm-windows
  - Run nvm install latest
  - Run nvm list (to see the versions of NPM/node.js available)
  - Run nvm use latest (to use the latest available version)

To start the React web app:

Navigate to the ui/medical-claims-ui folder
Run npm install to restore the packages
Run npm run dev
Open localhost:3000 in a web browser

Run the solution locally using Visual Studio

You can run the website and the REST API provided by the Azure Function App that supports it locally. You need to first update your local configuration and then you can run the solution in the debugger using Visual Studio.

Configure local settings

Note: Only complete these steps if you did not deploy the solution to Azure using the deployment guide. The deployment scripts create the appsettings.Development.json files for you. If these files do not exist for some reason, you can follow these steps to create them.

In the CoreClaims.WebAPI project, copy the appsettings.Development.template.json file and name it appsettings.Development.json. This file should like similar to this (make sure you replace the {{suffix}} and other placeholders with your deployed resource names):

{
  "AllowedHosts": "*",
  "CoreClaimsCosmosDB:accountEndpoint": "https://<...>.documents.azure.com:443/",
  "CoreClaimsEventHub:fullyQualifiedNamespace": "eh-coreclaims-{{suffix}}.servicebus.windows.net",
  "BusinessRuleOptions": {
    "AutoApproveThreshold": 200,
    "RequireManagerApproval": 500,
    "DemoMode": true,
    "DemoAdjudicatorId": "df166300-5a78-3502-a46a-832842197811",
    "DemoManagerAdjudicatorId": "a735bf55-83e9-331a-899d-a82a60b9f60c"
  },
  "RulesEngine": {
    "OpenAIEndpoint": "{{openAiEndpoint}}",
    "OpenAIKey": "{{openAiKey}}",
    "OpenAICompletionsDeployment": "{{openAiDeployment}}"
  }
}

In the CoreClaims.WorkerService project, copy the appsettings.Development.template.json file and name it appsettings.Development.json. This file should like similar to this (make sure you replace the {{suffix}} and other placeholders with your deployed resource names):

{
  "AllowedHosts": "*",
  "CoreClaimsCosmosDB:accountEndpoint": "https://<...>.documents.azure.com:443/",
  "CoreClaimsEventHub:fullyQualifiedNamespace": "eh-coreclaims-{{suffix}}.servicebus.windows.net",
  "BusinessRuleOptions": {
    "AutoApproveThreshold": 200,
    "RequireManagerApproval": 500,
    "DemoMode": true,
    "DemoAdjudicatorId": "df166300-5a78-3502-a46a-832842197811",
    "DemoManagerAdjudicatorId": "a735bf55-83e9-331a-899d-a82a60b9f60c"
  }
}

In the CoreClaims.Publisher project, copy settings.template.json to a new file named settings.json and make sure it looks similar to this:

{
  "GeneratorOptions": {
    "RunMode": "OneTime",
    "BatchSize": 10,
    "Verbose": true,
    "SleepTime": 1000
  },
  "CoreClaimsCosmosDB": {
    "accountEndpoint": "AccountEndpoint=https://db-coreclaims-{{suffix}}.documents.azure.com:443/;AccountKey={{cosmosKey}};"
  },
  "CoreClaimsEventHub": {
    "fullyQualifiedNamespace": "Endpoint=sb://eh-coreclaims-{{suffix}}.servicebus.windows.net/;SharedAccessKeyName=RootManageSharedAccessKey;SharedAccessKey={{eventHubKey}}"
  }
}

Running in debug

To run locally and debug using Visual Studio, open the solution file to load the projects and prepare for debugging.

Before you can start debugging the CoreClaims.WebAPI and CoreClaims.WorkerService projects, make sure the newly created appsettings.Development.json files are copied to the output directory in each project. To do this, right-click on the file in the Solution Explorer and select Properties. In the properties window, set the Copy to Output Directory property to Copy always..

You are now ready to start debugging the solution locally. To do this, you first need to set up multiple startup projects to run when you debug. Right-click the solution in Solution Explorer, then select Configure Startup Projects.... Set CoreClaims.WorkerService and CoreClaims.WebAPI to Start under Action. All others should be set to None. When you're ready to debug, press F5 or select Debug > Start Debugging from the menu.

NOTE: With Visual Studio, you can also use alternate ways to manage the secrets and configuration. For example, you can use the Manage User Secrets option from the context menu of the CoreClaims.WebAPI and CoreClaims.WorkerService projects to open the secrets.json file and add the configuration values there.

Teardown