The technological capabilities of Medi Assist have empowered the entire insurance ecosystem

Third Party Administrators (TPAs) have continued to play a very important role in the processing of health insurance claims. Now it has become much easier for policyholders to take advantage of Mediclaim benefits. In fact, the pandemic pushed Insurtech funding to an all-time high. Additionally, the pandemic has prompted many insurers to ramp up their digital transformation efforts and seek support from TPAs ​​who can help speed up Mediclaims. In an interaction with Express Computer, Himanshu Rastogi, Chief Technology Officer of Medi Assistdescribes how the company has relentlessly innovated to transform the claims processing and member experience through superior technology and an efficient, well-trained workforce.

As one of the top TPAs ​​in the country, how have you transformed your services with the help of enterprise technologies like cloud, data analytics, AI/ML, etc.?

From advanced data analytics and machine learning to automation, the InsurTech space is harnessing disruptive technologies that are transforming the way our industry delivers services and designs products, and Medi Assist is leading the way.

At Medi Assist, all of our processes are data driven and supported by technology. At every step of administering benefits for our members, we use various technologies to enhance the end-user experience. We implement AI-based technologies to forecast the number of admissions, patient discharges, etc., on a given day or time. We use combinations of AI and ML to read the financial summary around a patient’s admission. This is a combination of native OCR and extended by NLP in the medical domain. We have several models that work in conjunction with the above to determine and predict fraud, abuse, and waste around submitted invoices. We enable portfolio analytics for our clients that allows them to understand their premium spend, usage, and other operating KPIs to enable better decision making.

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What are some of the technology initiatives undertaken specifically in the last two years that have helped Medi Assist through unprecedented times?

The last two years have accelerated the adoption of technology in all sectors. While technology before the pandemic played a big role in Medi Assist’s operations, there have been several accelerated efforts to not only expand our operations, but also help the entire insurance ecosystem work better. We help members/policyholders anticipate out-of-pocket costs with the Out-of-Pocket Navigator.

Our claims are automated through MAtrix, an AI/ML enabled platform. Insurance companies use our homegrown technology stack/platform as a service and our network as a service. Our technology platform has made it easy to file paperless claims for hospitals. In a nutshell, Medi Assist’s technological capabilities have empowered the entire insurance ecosystem.

Highlight the digital innovations being introduced to your services that have enriched the overall customer experience?

The customer experience is at the epicenter of all innovation and technology at Medi Assist. From claim filing, to fraud detection, to reimbursement, our technology stack is built on making customers’ lives easier. Our fraud detection engine detects and manages fraud as claims are filed. The out-of-pocket navigator helps policyholders anticipate the amount they would have to pay if their policy doesn’t fully cover health expenses. Our technology team has also created an end-to-end digital claim journey, starting with a DIY eCard, web and app e-cashless facilities, digital pre-authentication, automated claims processed through MAtrix, stack AI-ML for precise digitization of records and digital communications

How has AI/ML been as a beneficial technology for the health insurance sector (mediclaim processing) and TPA? Cite examples where Medi Assist has been leveraging AI/ML to automate processes?

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At Medi Assist, the technology team is solving industry problems by creating solutions that are one step ahead of the rest. Matrix, one of our in-house built technology products, went on to define claims automation within the insurance ecosystem. Matrix makes use of AI/ML for digitization and efficient claims processing.

Any particular technology you’re betting big on that would transform your services in the near future?

● Robotic Process Automation (RPA) – for greater precision in the human-driven process so we can run machines 24 hours a day without disrupting core systems.
● Data Fabric: to consolidate data and democratize parts of it
● Chat bot: to respond to customer inquiries in real time

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