Health insurance turns digital

While technology has made everything from travel bookings to long-distance communication easy, the medical insurance segment has been slow to adapt. While information regarding patient particulars are entered into computer systems at the hospital’s billing desk, treatment-related information is often manually written by doctors. The hospital sends the patient’s documents to the insurance company, for them to be assessed at multiple levels by the insurer for the patient’s eligibility. The computer systems at hospitals are often not compatible with those at the insurance companies. It is estimated that many hospitals spend nearly 8% to 10% of their revenue on managing this laborious process.

Software making a difference

However, cloud-based platforms — connecting the system at the hospital and at the insurance company — are making a difference. Overcoming incompatibility problems, the software converts the hospital data into one standard form, as recommended by IRDAI (Insurance Regulatory and Development Authority of India). At the insurer’s end too, there is a software system that processes and adjudicates the insurance claims.

“We get information from the hospital, not in a scanned or PDF format, but as individual data, line by line, like in an Excel sheet,” said Munish Daga, CEO, Remedinet Technologies, a Bengaluru-based start-up that was launched in 2011. “We then push that information through API integration to the insurer. Data entry is eliminated, because we are able to map the entire hospital information to the insurer’s platform. Thus, manual data entry and technical evaluation time are minimised to a great extent.”

The process has been gathering pace in the past couple of years, with the platform being adopted for many government schemes. “The Tamil Nadu government has one that covers some five to six crore people. These are totally cashless and paperless schemes. Nearly 30,000 to 40,000 claims are made in a month in Tamil Nadu,” says Daga. “Karnataka’s Vajpayee Arogyashree Scheme is another one. Recently, we deployed it for Karnataka police’s Arogya Bhagya Yojane.”

Advantages aplenty

The rapid pace of progress isn’t surprising, considering the many benefits the technology brings to patients, hospitals and insurance companies.

“When a patient is admitted, the details are uploaded by the hospital to the Remedinet platform,” says Satish HS, Manager, Insurance, Cloudnine group of hospitals. “An automatic alert goes to the insurance platform concerned, and a reply from them comes in about two hours. There is no need to send multiple documents by email to insurance companies or TPAs (third-party administrators). This doesn’t have the problem of file size while sending documents as attachments in email.”

Another advantage is that patients know their insurance eligibility before getting admitted. “Often patients, unaware of their eligibility, for example, choose a type of room that might not be covered under the policy. Now, the insurance company, before the admission of the patient itself, weighs in with the actual eligibility, and the patient is able to make appropriate choices regarding the type of room, facilities etc,” says Satish.

The technology of Remedinet, which is backed by Rakesh Jhunjhunwala and Bessemer Venture Partners, is being used by around 300 hospitals in cities such as Bengaluru, Chennai, Hyderabad, Mumbai, Pune, and Delhi, among others; besides five insurance companies and two third-party administrators.

Encouraged by the rapid adoption of digitisation, Remedinet is working with many PSUs to adopt this scheme; and also to introduce insurance for day care or outpatients.

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Printable version | Oct 27, 2020 11:24:03 AM |

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