Insurers plan health insurance info exchange system to combat fraud
Health insurers in Kenya are planning to develop an information exchange system that will allow insurers to share data in an effort to enhance services and prevent fraudulent claims
The Association of Kenya Insurers launched a proposal in August asking for tenders for consultants to develop an all-inclusive Health Information Exchange and Management System that will enable medical underwriters and health service providers to share agreed information on real-time basis.
The consultant will be expected to create a system that will provide a range of fees for various medical procedures and anything above the upper limit will 'trigger an alert for special authorisation in a bid to catch cheats', reported Business Daily Africa.
It is hoped that a new system, which would be expected to flag claims over a certain amount, will also be able to share coded data on insurers and customers to prevent fraud an enable better services to be provided to all parties. By gathering and analysing the insurance claims data, it will in time be a means for detecting fraudulent patterns in both underwriting and claims.
A similar system launched in 2018 for motor insurers.