M-Tiba, a health insurance technology platform, has integrated artificial intelligence (AI) into its claims processing system to reduce the waiting time for approval to less than 12 hours.
The integration will allow underwriters to focus on more complex assessments. Typically, claims approval times can range from three hours to several days, depending on the insurer and whether the patient is an outpatient or inpatient.
M-Tiba aims to use technology, particularly machine learning (ML) models, to improve efficiency and fraud management. This will result in reduced administrative and medical costs for health insurance providers, enabling them to offer more affordable health insurance products to their customers.
“The AI solution is seamlessly integrated into our claims assessment process. This new system enables us to expedite claims reviews significantly. This innovative technology, developed and tested over the past three years, complements our existing systems, automating claim approvals without requiring manual review for each submission," said Shadrack Kiratu, head of pricing and portfolio management at M-Tiba.
The platform has been automating the assessment of health insurance claims for the past three months, resulting in faster payments to providers. Currently, over 40 percent of claims can be automated.
"Previously, manual review of claims prolonged the approval process because traditional technologies are not scalable. With AI technology, we can automate claims assessment at scale, allowing our insurance clients to grow faster and our team to focus on more complex claims that require additional expertise. With a more efficient system in place, insurers can pass these benefits on to their members in the form of more affordable health insurance products, making healthcare more accessible to a wider population," Mr Kiratu added.
The Association of Kenya Insurers' market report has highlighted an increase in claims frequency in recent years, raising concerns that the cost of handling claims could become more expensive for insurers if they do not adopt advanced technology to process claims.
Regulations require insurers to determine whether to admit or deny liability, identify claimants, determine payment amounts, and make payments within 90 days.
