[E-Newspaper Writing] To simplify claims for loss insurance, to be rea…
lemonhealthcare
2023-05-15
Among the government's key digital platform government projects, one of the five tasks proposed in the "National Emotion Leading Project" is "Simple Claiming for Loss Insurance." This means that simplifying claims for loss insurance is important as a digital service that enhances public convenience. But I can't help but wonder why it's so difficult to realize.
Since the recommendation of the Anti-Corruption and Civil Rights Commission in 2009, an amendment to the Insurance Business Act, a corporation that simplifies claims for real-life insurance, has not been passed by the National Assembly for 14 years.
In the meantime, the development of digital technology has led to changes in the industrial ecosystem.
Experts may know that the amendment to the Insurance Business Act is not the only alternative to simplifying claims for loss insurance. To simplify claims for loss insurance, many FinTech and InsureTech companies are already providing medical institutions with loss insurance claims that do not require outpatient and inpatient medical expenses documents in conjunction with electronic medical record (EMR) databases.
In December last year, a service in which medical data for medical institutions' claims are automatically transmitted to insurance companies after treatment was completed was developed by a fintech company and started a pilot service centered on high-level general hospitals and general hospitals. This shows that digital technology can be a sufficient alternative to simplifying claims for loss insurance.
I would like to present a digital ecosystem to simplify claims for loss insurance as an alternative to the amendment to the Insurance Business Act, which has been working hard to realize the simplification of claims for loss insurance for the past six years in the medical community.
First, 17 non-life insurers and 24 life insurers in Korea currently require different medical data sets from the insured when receiving documents for loss insurance, but the minimum medical data set necessary for loss insurance claims should be designated and standardized. In addition, a process should be established to standardize the form of insurance bills of each insurance company and to notify them in advance when changing the form. This is a task that needs to be reflected in the revision of the Insurance Business Act, as well as must be decided in order to realize the simplification of claims for loss insurance.
Second, the medical community should determine, develop and provide a standard application development environment (API) so that private companies can call the standard medical data set required by insurance companies as proof of insurance claims to transmit the insured medical data stored in medical institutions in electronic documents. In addition, each insurer should standardize different professional communications protocols or switch to a system that receives medical data sets from transmission agencies in a standard API to receive standard medical data sets from medical institutions. In that case, the spread of services to simplify claims for real-life insurance could be made at least 10 times faster than now.
Third, as of 2021, there are 35,243 medical institutions in Korea, but unlike financial institutions, few have their own information technology (IT) organizations of a certain size or larger. In particular, since doctors and hospitals hardly have their own IT organizations and use packages provided by medical information service (EMR) companies, they will not be able to develop and provide standard APIs to call medical data sets for simplifying claims for loss insurance. To solve this problem, if companies that supplied EMR to doctors and hospitals develop and provide standard APIs, the billing simplification service will be able to spread rapidly. However, incentive policies for medical and hospital-level EMR suppliers are needed.
Fourth, since simplifying claims for loss insurance requires processing sensitive personal medical data, policies such as the operational guidelines presented to each MyData operator in the financial MyData business are needed. In order to simplify claims for loss insurance, standard operating guidelines should be presented, managed, and supervised to companies that provide transmission agency services.
The private sector is already making important progress in simplifying claims for loss insurance. Rather than trying to reinvent the wheel, the government should acknowledge and support these efforts by the private sector. A more efficient and insured-friendly service can be created in which the public and the private sector work together to benefit all the people.
출처 : https://www.etnews.com/20230427000203
Since the recommendation of the Anti-Corruption and Civil Rights Commission in 2009, an amendment to the Insurance Business Act, a corporation that simplifies claims for real-life insurance, has not been passed by the National Assembly for 14 years.
In the meantime, the development of digital technology has led to changes in the industrial ecosystem.
Experts may know that the amendment to the Insurance Business Act is not the only alternative to simplifying claims for loss insurance. To simplify claims for loss insurance, many FinTech and InsureTech companies are already providing medical institutions with loss insurance claims that do not require outpatient and inpatient medical expenses documents in conjunction with electronic medical record (EMR) databases.
In December last year, a service in which medical data for medical institutions' claims are automatically transmitted to insurance companies after treatment was completed was developed by a fintech company and started a pilot service centered on high-level general hospitals and general hospitals. This shows that digital technology can be a sufficient alternative to simplifying claims for loss insurance.
I would like to present a digital ecosystem to simplify claims for loss insurance as an alternative to the amendment to the Insurance Business Act, which has been working hard to realize the simplification of claims for loss insurance for the past six years in the medical community.
First, 17 non-life insurers and 24 life insurers in Korea currently require different medical data sets from the insured when receiving documents for loss insurance, but the minimum medical data set necessary for loss insurance claims should be designated and standardized. In addition, a process should be established to standardize the form of insurance bills of each insurance company and to notify them in advance when changing the form. This is a task that needs to be reflected in the revision of the Insurance Business Act, as well as must be decided in order to realize the simplification of claims for loss insurance.
Second, the medical community should determine, develop and provide a standard application development environment (API) so that private companies can call the standard medical data set required by insurance companies as proof of insurance claims to transmit the insured medical data stored in medical institutions in electronic documents. In addition, each insurer should standardize different professional communications protocols or switch to a system that receives medical data sets from transmission agencies in a standard API to receive standard medical data sets from medical institutions. In that case, the spread of services to simplify claims for real-life insurance could be made at least 10 times faster than now.
Third, as of 2021, there are 35,243 medical institutions in Korea, but unlike financial institutions, few have their own information technology (IT) organizations of a certain size or larger. In particular, since doctors and hospitals hardly have their own IT organizations and use packages provided by medical information service (EMR) companies, they will not be able to develop and provide standard APIs to call medical data sets for simplifying claims for loss insurance. To solve this problem, if companies that supplied EMR to doctors and hospitals develop and provide standard APIs, the billing simplification service will be able to spread rapidly. However, incentive policies for medical and hospital-level EMR suppliers are needed.
Fourth, since simplifying claims for loss insurance requires processing sensitive personal medical data, policies such as the operational guidelines presented to each MyData operator in the financial MyData business are needed. In order to simplify claims for loss insurance, standard operating guidelines should be presented, managed, and supervised to companies that provide transmission agency services.
The private sector is already making important progress in simplifying claims for loss insurance. Rather than trying to reinvent the wheel, the government should acknowledge and support these efforts by the private sector. A more efficient and insured-friendly service can be created in which the public and the private sector work together to benefit all the people.
출처 : https://www.etnews.com/20230427000203
