In an industry attempted to be governed by a somewhat confused regulator, completely fragmented provider side, health insurance companies in India struggle to make real straight through claims processing a reality. A small number of claims passing through limited expanse rules-engines don’t count.
Complete lack of trust among payer and provider, as many data formats as entities, half completed ICD codes, data being transported through emails in PDF files and images, multiple insurance company portals are just a few among the problems which prevent quick processing or detection of fraud. The payer side is an industry plagued with almost non-existent underwriting profit, but high investment profit from float money finally aided with low cost labour. The insured ends up paying for the inefficiencies.
This is not an unsolvable problem. Sounds like a Blockchain based solution, doesn’t it? But, there is no blockchain instance (in this industry) around.
The problem isn’t really a technology one, it is of people, of organizations. …..Click here to read full article
About the Author: Suhas is co-founder, Partner at 3nayan, a niche consulting firm which uses Process Engineering, Robotic Process Automation and Digital Transformation for Strategy Re-Energization, Growth Enablement and Organizational Effectiveness of organizations.