Hospitalisation is a stressful event
Unnecessary time spent by the patient’s family in arranging for paperwork for Insurance could be better spent with the patient
Lack of transparency throughout Claims lifecycle
Customers want to be kept informed throughout every stage of claims lifecycle
For Insurance Providers
Heavy Claims Processing Costs
Cost of Claims Processing stands at a 10-12% of total Operating Expenses
Fragmented TATs dilutes Customer Experience
The TAT is not standardised even within the same Insurer, due to multiple claim processing entities(TPA)
Pre-Auth Experience (Before Treatment) is fragmented even
within the same provider depending on which TPA you are using.
*(IRDAI enforces an SLA of 6 hr pre-auth process)
Post-Discharge (After Treatment) experience become even more fragmented (varying from 95% to 60% claims being processed in <1hr) depending on which TPA you are using
How do we solve It?
National Health Stack(NHS) is trying to push for digitization of health documents. Which opens up the possibility to revolutionize the claim processing.
Getting rid of the physical documents collection & manual claim processing method and replacing it with automated rule engine can help us reduce the time required to process claims by order of magnitude.
Personal Health Records
ClaimGenie collects the health records from the PHR database being created as part of the National HealthSatck
E-Claim *(based on 15C) that allows Providers to send us patient’s data in standardized format over an API
Policy Markup Language
Policy Markup Language, that allows us to convert any Policy to a set of machine readable rules/conditions
Rules engine that allows us to compare b/w patient’s medical records to what’s allowed in her policy
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