Health insurance companies in Brazil have their data about claims organized having the view only for service providers. In this way, they lose the view of physicians' activity and how physicians share patients. Partnership between physicians can be seen as fruitful, when they team up to help a patient, but could represent an issue as well, when a recommendation to visit another physician occurs only because they work in same clinic. This work took place during a short-term project involving a partnership between our lab and a large health insurance company in Brazil. The goal of the project was to provide insights (with business impact) about physicians' activity from the analysis of the claims database. This work presents one of the outcomes of the project, i.e., a way of modeling the underlying referrals in the social network of physicians resulting from health insurance claims data. The approach considers the flow of patients through the physician–physician network, highlighting connections where referrals between physicians potentially occurred. We present the results from the analysis of a claims database (detailing 18 months of activity) from the health insurance company we partnered with. The main contribution presented in this paper is the model to reveal mutual referrals between physicians. Results show the proposed model reveals underlying characteristics of physicians' activity from real health insurance claims data with multiple business applications.

巴西的健康保险公司将有关理赔的数据组织为仅对服务提供商可见。这样，他们就失去了医生活动以及医生如何共享患者的视野。当他们联手为患者提供帮助时，医生之间的合作可以被认为是富有成果的，但是当仅仅因为他们在同一家诊所工作而提出拜访另一位医生的建议时，也可以代表一个问题。这项工作是在一个短期项目中进行的，该项目涉及我们的实验室与巴西一家大型健康保险公司之间的合作关系。该项目的目的是通过理赔数据库的分析提供有关医生活动的见解（具有业务影响）。这项工作是该项目的成果之一，即 一种根据健康保险理赔数据对医生的社交网络中的基础推荐人进行建模的方法。该方法考虑了患者通过医师-医师网络的流动情况，突出了可能发生医师之间转诊的联系。我们提供了与我们合作的健康保险公司的理赔数据库（详细工作18个月）的分析结果。本文提出的主要贡献是揭示模型 我们提供了与我们合作的健康保险公司对索赔数据库（详细活动为18个月）的分析结果。本文提出的主要贡献是揭示模型 我们提供了与我们合作的健康保险公司的理赔数据库（需要活动18个月）的分析结果。本文提出的主要贡献是揭示模型医师之间的相互推荐。结果表明，提出的模型从具有多个业务应用程序的真实健康保险索赔数据中揭示了医生活动的潜在特征。