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Automated Claims Management Decreases Cost

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Yogesh Lohiya, MD & CEO, Iffco Tokio, General Insurance Company Ltd

What is the importance of Health Insurance Claims Management (HICM) in the healthcare and insurance industry?Managing claims involves not only claims processing but goes on to cover the entire gamut of claims management– strategic role, cost monitoring role, service aspect as well as the role of people handling the claim.
Promptness, fairness, correctness and transparency in claims settlement are the keys to customer satisfaction.This is not only a business responsibility but also a responsibility towards masses/society. Suitable claims management leads to a possibility of maintaining better ratios of claims resulting in better pricing of premium.
Furthermore, from the perspective of the insurance industry, HICM is very important to build a sustainable portfolio. In the absence of any regulation or regulator in our country to control the healthcare providers,coupled with no standardisation of protocols and tariffs nor categorisation and certification of healthcare providers, the area of HICM attains even greater relevance and importance.

How crucial the role of Information technology is in health insurance claims management?
Claims handling is an important activity due to increasing expectations on the part of consumers and compliance with Government regulations. Efficient claims management is vital to the success and sustenance of the portfolio.Major components of the claims handling process include developing strategies to cut costs and reduce fraud while keeping customers satisfied. Companies can benefit from claims management tools and technology.
Earlier to the year 2000, the process of claims management only involved reimbursement claims and it used to be slow and fully paper/document based,with no role for IT. With the advent of cashless hospitalisation, the entire claim process changed. New processes,such as prior authorisation became vital. Time, which was not a crucial element in processing reimbursement claims earlier, all of a sudden became a vital parameter. The use of claims management system software that speeds the process and minimises costs offered a practical solution. Simplifying the claims process through automation helps reduce expenses.
Automation of the claims management process helps decrease a company’s operating costs. One example is the increased cost of investigating a claim manually. Information technology systems improve efficiency by decreasing the number of claim errors, detecting fraud early and reducing the time it takes to process and settle a claim — all factors that cut costs and increase profitability.Also, paying fraudulent claims costs insurance companies money — a cost it passes on to its customers. Consequently,underwriting guidelines become tougher and the insurance premiums that the consumers pay increase.Software tools designed to examine payment history and evaluate trends in claim payments can help insurance companies detect fraud.
Information Technology is one of the best enablers for data storage, data mining and the very important area of data analytics. With the increasing numbers, it is expensive and cumbersome to keep all information in paper form. Furthermore to retrieve the huge voluminous data and analyse it is a near impossible task. It is here that IT comes in as a valuable aide.Last, but not the least, an effective  IT based claims management system can provide excellent insight to management.

Where do you see the future of health insurance and claims management?
Health insurance is growing at a fast pace. In 2012-13 health insurance contributed 22 percent to the total general insurance premium and grew at 17 percent.This is due to many contributors such as a growing population, poor state owned health services and due to overdependence on private service providers – exorbitant medical costs coupled with no medical insurance coverage for the majority. Over and above this, increasing shift of people from rural active lifestyle to urban sedentary lifestyle, poor dietary choices and stress has led to a spurt of lifestyle diseases in India.

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