Healspan’s Abhishek Sinha Shares How Tech is Reshaping Claims Processing

Digitization has disrupted the claim processing system in healthcare drastically. Central to the evolution are ventures like Healspan, which with its streamlined solution for healthcare insurance claims processing, contributes to the overall growth of the sector.

Learn about those cutting-edge transformations of claims processing through the lens of Abhishek Sinha, the cofounder of Bengaluru-based insuretech startup Healspan.

Introduction

In India, the health insurance industry has long grappled with the challenges of paper-heavy claims processing. Despite some rather significant strides in digitization, the sector has lagged behind in fully leveraging technology for efficient claims management.

Unlike some of the developed markets, medical encoding is yet to become widespread, leading to a ton of unutilized data. This has resulted in inefficiencies, data duplications, and an arduous journey for customers seeking timely claims processing.

However, the winds of change are blowing as the industry embraces cutting-edge technologies, promising a revolution in the way health insurance claims are handled. This is particularly enabled by the stance of the regulatory bodies which have been pushing for digitization.

The Current Scenario

Traditionally, health insurance claims processing in India has been marred by a reliance on paper-based documentation. While some improvements have been made in digitizing documents, the core processing involves manual data entry and assessment, leading to a myriad of inefficiencies.

Unlike the banking sector which has transitioned to seamless digital transactions, the insurance industry has been slow to trust technology. Most digitization in this sector has been limited to storing scanned documents instead of hard copies.

Medical encoding, a crucial process in claims management, is yet to gain widespread acceptance in India. This means that vast amounts of valuable medical data remain untapped, locked in various formats, and scattered across the industry. This lack of standardization creates a need for multiple data entries at different stages of claims processing, resulting in redundancy and delays.

The Technological Leap

The future of health insurance claims processing in India is undergoing a paradigm shift, much like the banking industry's move towards digital transactions.

Multiple insurers are now at the forefront of a digital transformation, leveraging state-of-the-art tools in AI and imaging technology to streamline processes, reduce duplication, and enhance customer experiences.

AI's Role in Claims Processing

One significant stride in this potential transformation is the use of AI for automating the encoding of medical data and assessing bills. By employing ML algorithms, insurers can significantly reduce the time required for claim approvals and payments.

AI systems can (potentially) accurately interpret medical records, eliminating the need for extensive manual reviews and expediting the entire claims adjudication process. While this is still not fully a reality, this may become commonplace in the coming years.

Blockchain for Fraud Prevention

Another promising avenue is the integration of blockchain technology in health insurance claims processing.

Blockchain offers a secure and transparent way to maintain a digital trail of documents, reducing the risk of fraud without compromising patient confidentiality. Establishing a foolproof digital record of transactions can eliminate the reliance on paper-based processing and enhance the overall integrity of the claims process.

Regulatory Push toward Paperless

The regulatory landscape is also evolving to drive the health insurance sector towards a paperless future.

Initiatives such as the creation of the National Health Claim Exchange (HCX) and the establishment of data standardization and transmission guidelines reflect a commitment to modernizing the industry.

In the same manner, as Unified Payments Interface (UPI) revolutionized currency transactions, these regulatory nudges can create a standardized and efficient ecosystem for health insurance claims processing.

Collaboration between Established Companies & Startups

A crucial catalyst in making this vision of the future real is the collaborative efforts between established insurance companies and deep tech startups.

Recognizing the need for expertise in cutting-edge technologies, traditional insurers are partnering with nimble startups specializing in AI, blockchain, and data analytics in various areas of insurance underwriting and processing.

This collaboration brings together the industry experience of established companies and the innovation-driven agility of startups to create comprehensive solutions.

These partnerships are fostering a dynamic ecosystem where established players are leveraging the technological prowess of startups to implement efficient claims processing systems.

Startups, in turn, gain valuable industry insights and access to a wider market through collaboration with established insurers. This synergy is pivotal in driving the development and implementation of advanced technologies that promise to reshape the health insurance landscape.

Conclusion

As technology takes center stage, reshaping health insurance claims processing in India, the industry stands at the cusp of a transformative era.

The shift from paper-heavy processes to digitized, AI-driven workflows promises to enhance efficiency, reduce fraud, and improve the overall customer experience.

With regulatory support and industry-wide collaboration between established players and startups, the vision of a paperless future for health insurance claims processing in India seems closer than ever.