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ICICI Lombard Launches India’s First AI To Automate Health Insurance Claims

ICICI Lombard Launches India’s First AI To Automate Health Insurance Claims

ICICI Lombard General Insurance has used artificial intelligence to provide instant health insurance claim approval. Reportedly, the system can scan the documents sent by the hospital and match them with the medical coverage.

Earlier, this was a cumbersome process involving many persons:

  • Doctors looked at the cases
  • Executives entered the data and balance
  • Checking the balance sum insured
  • Going through the room rent limits for the insured

This entire process would take over 60 minutes.

Now, because of this new AI-powered system aided by OCR, the process can be carried out in just one minute.

As of now, ICICI Lombard General Insurance is using AI for cataract, maternity, appendicitis, haemodialysis and hysterectomy. The company is now looking forward to expanding it to more sectors.

Speaking to one of the leading newspapers, ICICI Lombard executive director Sanjeev Mantri said, “So far, AI has only been used in terms of chatbots doing simplistic service request. Understanding medical diagnosis is a much complex activity for which we have deployed AI technology. With AI over the medical admissibility decisions currently done by doctors, it will enable our doctors to focus on more complex jobs, including better fraud detection.”

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According to Mantri, the system is already up and running successfully. Using this system, he mentioned a case where they had sent a sanction to a patient in Visakhapatnam. He said that the patient was admitted to the hospital for an operation of appendicitis at 08:15 pm. The hospital used the online portal to submit the cashless request at 08:35 pm and the sanction was sent at 08:36 pm. So, the whole process of scrutinising was brought down drastically.

The system does not work in case of a failure of the proposal acceptance. In such a case, an alert is received, and the papers are checked manually.

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