MUMBAI: Star Health Insurance, the country’s largest health insurer, expects most cashless treatment claims in hospitals to be settled directly through the use of artificial intelligence within two years.
Currently, one-fifth of claims are settled using AI to help the company meet pre-hospital and post-discharge timelines.Guidance from the regulatory body requires the pre-admission clearance to be completed within one hour and the post-discharge clearance within three hours, which requires efficiency.“Non-cash claims represent about 85% of claims value and about 70% in number. About 20% of claims are processed directly through the use of AI without human intervention, and we aim to increase this to more than 50% within two years.
Human intervention will primarily be for exceptions, high-value claims or suspected fraud, Star Health CEO Anand Roy said.“Cashless claims” are those in which hospitals agree to a rate schedule with the insurance company, which then approves treatment once it receives an order from the hospital. In the absence of regulations on hospital pricing, the General Insurance Council enters into agreements on price schedules with individual hospitals.
“The Council is working on joint equipping of hospitals, with the aim of onboarding at least 10,000 facilities. The focus is on transparent billing, standardized treatment protocols, and digital integration through initiatives such as NHCX and ABHA.