A big challenge to effectively automating claims processing for African Health Insurers is tariff management. Tariffs refer to the price list for medical consumables and services agreed between a health insurer and their healthcare providers. Health insurers work with hundreds or thousands of providers which means different tariff prices and different tariff formats. Getting standardised tariff formats (names of consumables and services) is a herculean challenge, especially when tackled without technology.
Thanks to Curacel’s technology, AXA Mansard has been able to standardize tariffs for all 1,700 of its providers. This is the first true step in achieving a high degree of automation with claims processing – collection, adjudication, reconciliation and payments.
“We had attempted to standardise our tariffs internally for years without much success. When Curacel approached us with their Claims and Fraud Detection software, we decided to give them the standardization project and they have massively delivered. Our journey towards fast and efficient claims processing has only just begun.”
– Dr. Omolola Odedere, Head, Fraud, Waste & Abuse, AXA Mansard Health.
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