Star Health Insurance, India's largest health insurance company, expects most cashless hospitalisation claims to be settled straight through using artificial intelligence within two years. According to reports from The Times of India, currently, a fifth of the claims are settled using AI helping the company meet regulatory timelines. The company aims to increase this percentage to over 50% in two years, with human intervention primarily reserved for exceptions, high-value claims, or suspected fraud.
Cashless claims account for about 85% of claim value and roughly 70% by number. As reported by The Times of India, around 20% of claims are processed straight through using AI without human intervention. The company processes these claims under the General Insurance Council's schedule of rates agreements with individual hospitals, with the focus on transparent billing, standardised treatment protocols, and digital integration through initiatives such as NHCX and ABHA.
The company operates under strict regulatory timelines requiring completion of pre-admission authorisation within one hour and post-discharge authorisation within three hours. According to The Times of India, these directives from the regulator necessitate operational efficiencies that AI technology can help achieve. Cashless claims are those where hospitals agree to a schedule of rates with the insurer, who then approves treatment once a request is received from the hospital.
The General Insurance Council is working towards common empanelment of hospitals, with a target of onboarding at least 10,000 facilities. As reported by The Times of India, in the absence of regulations on hospital pricing, the Council is entering into agreements on a schedule of rates with individual hospitals. The focus remains on transparent billing, standardised treatment protocols, and digital integration through initiatives such as NHCX and ABHA.
