Insurtech Startup i3systems Develops India’s First COVID Claims Automation Solution, CliniAId, to Approve Discharge Claims in 30min

  • ‘CliniAId’ enables insurers & TPAs to run critical billing and medical validations in less than 10 minutes of handling time
  • ‘CliniAId’ is pre-trained AI-models to read complex medical documents in any format from 70,000+ hospitals in India
Insurtech startup i3systems built CliniAId’, India’s first intelligent automation solution to approve COVID-19 discharge claims in under 30 minutes. CliniAId enables insurers and TPAs to manage end-to-end COVID-19 claims processes by automating financial & medical adjudication using Artificial Intelligence. The solution is easy to integrate, can be deployed frictionlessly in a few hours, and comes at a time when Indian insurers are swamped with about 45000 number of COVID claims per day.

IRDAI recently issued a directive for insurers and TPAs to process COVID-19 cashless claims within 60 minutes. But due to the complexity of COVID-19 treatment insurers need additional 60 minutes of Average Handling Time (AHT) to process COVID-19 related claims. Hence, to reduce the overhead of claims adjudicators and comply with the new policy, CliniAId will play a critical role enabling adjudicators to approve discharge claims in under 30 minutes.

“The sudden rise in claims because of the pandemic situation and also increasing awareness around health insurance necessitated solutions that enable faster claim processing,” said Dr. Mallesh Bommanahal, Co-founder & CEO, i3systems. He further added, “CliniAId provides the insurers & the TPAs the power of modern Artificial Intelligence, automation and related digital technologies for speedy claim-approvals. Our focus is on the future, when claims processing ceases to be cumbersome for the multiple stakeholders involved in the process; most importantly, already distressed patients.”

CliniAId leverages pre-trained AI-models to read complex medical documents in any format from 70,000+ hospitals in India such as discharge summaries, invoices, diagnostic reports, etc. The solution then identifies the medical condition, matches it to the diagnostic data and validates the treatment plan within seconds. This enables the medical professional to approve the claim in less than 10 minutes, instead of 30+ minutes. Furthermore, CliniAId fastens the discharge approvals by automating admissibility of the claims and medical adjudication, thereby ensuring claims meet standard treatment guidelines as mandated by IRDAI.

Some of the key features of CliniAId:

 
  1. Better financial adjudication: Ensures accuracy of the output at 95% and above
  2. Faster Medical adjudication: Automated detection of severity and comorbidity, thereby bringing discharge time to under 30 minutes
  3. Fraud, Waste & Abuse (FWA) trigger- Flags cases with excessive billing, inconsistent reporting and deviation from customary benchmarks.

i3systems products currently enable 15 top insurers and TPAs in India & the Middle East to deliver operational excellence such as 80% reduction in processing time, 60% reduction in processing costs, 80% reduction in payment leakages and significant improvement in end customer satisfaction.

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