About US $61 Billion out of US $91 Billion in 2019 was spent as out of pocket expenses. Health Insurance needs transformation from legacy to build new age digital, personalised, connected and automated processes from filing, tracking to final settlement using AI, ML and Learning. There are many problems that exist in the health claims process, some of them are
Problems in Health Insurance Ecosystem
Patients find it difficult to file claims especially due to lack of awareness and also challenge in terms of what is needed and what to submit for claims.
Patients sometimes don't understand what is covered or what is not covered.
For more than 60% patients, health access is costly and they have no access to health insurance protection.
Digitization of Healthcare, Access to right health insurance products based on need is a challenge. Mental Health, Health advisory is still the biggest challenge.
What is doing in Health Insurance Claims Transformation?
Artivatic is a full-stack InsurTech that focuses on building new-age insurance and health solutions to solve the need of its customers and transforming into digital claims process. Artivatic has built health insurance stack to have 360 ecosystem in place.
Artivatic's is building 360 health ecosystem using tech and data to transform how real-time claims process can be settled. The important aspect of real-time claims settlement is to build connected journey to patients, providers and payers.
Unified Health and Insurance Platform
Unified Platform for Patients/Providers/Payers for using AI to Analyse pre-existing medical history, Disease prediction and recommendation for patients and providers and providing same information to payers for better health protection.
Document Digitization and Health Analysis
Processing Medical documents, billing, discharge summary and more. Analysing pre-existing medical history, Disease prediction and recommendation Reports/Analysis/Digitization.
Patient Advisory, Wellness and Risk Scoring
Mental Health /Reducing health/medical/operation costs and Real-time Risk identification. Lifestyle/Wellness mapping with new health devices and past clinical/diagnosis data to provide health risk recommendation, preventive healthcare to reduce medical costs and improving life.
Seamless Claims Pay-out. Access to Health Financing.
Instant unified AI Platform for claims assessment and pay-out connected with insurance /provider platforms. Access to Health Financing via Credit/Loyalty Cards/Low cost medical /health services on provider/patient side using risk-based analysis and decision.
Cashless + Reimbursement+ OPD + Hospicash + Loyalty Cards
Automated Medical documents digitization [Printed, scanned, Handwritten] > 90% Accurate
Reducing TAT up to 90%
Indexing system for medical records, billing, and other data to provide better risk assessment in real time, UP 50% better risk assessments
Fraud and abuse detection >30%
Connected ecosystem via APIs for patient, provider and payers - Easy Integration
Product configuration and rules edit engine - retail /group
Automated Medical Billing/Coding - IRDA/ICD10 etc.
Digital Pre-Auth and claims processing journey with digital consent process
Integration of NDHM for request for health data
Real-time claims status update, share documents, etc. without sending over email/whatsapp etc.
Real-time decision making engine for patients, providers and payers via Auto-adjudication and claims denial solutions
Self-learning and evolving system for better risk assessment, fraud and decision making
Workflows and Payment systems Integrated
Easy customized to the need for use to connect to any core claims system or use independently
Build health network digitally and assign benefits for health insurance products
Digital Tarif/SOC management system for approval, update and use [Without investing time for hospital manual contracts, record and negotiation]
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Artivatic launches ALFRED AI HEALTH CLAIMS solution for automating end-to-end health claims
ANI
Bengaluru, June 22
Health Insurance is a fundamental need now than just a protection. The important aspect in health insurance is to have claims process easy, smooth and digital.
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