M-Tiba, a leading health insurance technology platform, has revolutionized its claims processing system by integrating artificial intelligence (AI).

This innovative approach significantly reduces waiting times for claim approvals, bringing them down to under 12 hours.

Traditionally, claim approvals could take anywhere from a few hours to several days, depending on factors like the insurer and whether the treatment was received as an inpatient or outpatient.

The AI integration leverages machine learning (ML) models to streamline the process.

M-Tiba anticipates this will not only improve efficiency but also enhance fraud management. Reduced administrative and healthcare costs for insurers are expected outcomes, ultimately leading to more affordable health insurance products for consumers.

"We've seamlessly integrated the AI solution into our existing claims assessment process," said Shadrack Kiratu, Head of Pricing and Portfolio Management at M-Tiba.

"This new system significantly expedites claim reviews. Developed and rigorously tested over the past three years, this innovative technology automates claim approvals, eliminating the need for manual review of every single submission."

M-Tiba has already been reaping the benefits of AI for the past three months, with automated claim assessments resulting in faster payments to healthcare providers.

Currently, over 40 per cent of claims can be processed automatically.

"Previously, manual review of claims prolonged the approval process," explained Kiratu.

"Traditional technologies are not scalable. With AI technology, we can automate claims assessment at scale, allowing our insurance clients to grow faster and our team to focus on more complex claims that require additional expertise."

"With a more efficient system in place, insurers can pass these benefits on to their members in the form of more affordable health insurance products, making healthcare more accessible to a wider population," Kiratu added.

The urgency for M-Tiba's innovation is underscored by a recent report from the Association of Kenya Insurers.

The report highlights a concerning rise in claim frequency in recent years, raising the spectre of spiralling costs for insurers if they fail to adopt advanced technologies for claims processing.

It's important to note that regulations mandate insurers to make decisions on claim liability, identify beneficiaries, determine payout amounts, and settle claims within a 90-day timeframe.

M-Tiba's AI integration positions them to not only meet these regulations efficiently but also improve the overall healthcare experience for both policyholders and providers.