The Claims Directorate of the National Health Insurance Authority (NHIA) is set to introduce artificial intelligence (AI) training for its staff as part of efforts to enhance efficiency and accuracy in claims management.
According to the Acting Director of Claims, Dr. Abigail Nyarko Codjoe Derkyi-Kwarteng, the initiative aims to equip staff with the necessary skills to effectively leverage AI in their operations. The directorate will refine its protocols and business rules while deepening its understanding of AI’s application in medical claims management.
“We’re keen on leveraging AI to streamline our claims management process. To achieve this goal, we plan to train staff on the use of AI in claims management to enable them to effectively utilize AI in their work,” Dr. Derkyi-Kwarteng stated during an interview in Accra on Monday.
She emphasized that the introduction of AI would significantly enhance efficiency, reduce processing errors, and improve service delivery. As a result, the directorate is conducting an in-depth assessment of AI’s potential benefits in medical claims management.
NHIA Systems Integration to Enhance Efficiency
Beyond AI adoption, the NHIA Claims Directorate is also exploring the integration of various NHIA Management Information Systems. Dr. Derkyi-Kwarteng explained that the current claims and credentialing systems operate independently, leading to inefficiencies and delays in processing claims.
“By integrating these systems, we can create a more interconnected and responsive process. For instance, once credentialing is granted to a provider, the system can automatically recognize this status, reducing errors and delays in claims submissions,” she noted.
The integration will also enable automatic verification of providers’ credentials, preventing unnecessary claim rejections due to expired credentials. Additionally, healthcare providers will receive timely notifications about the expiration of their NHIS credentials, prompting them to renew their accreditation on time.
“This will not only enhance efficiency but also improve the experience of healthcare providers and patients, fostering greater trust in the NHIS,” she added.
Establishing a Claims Resource Portal
As part of its modernization efforts, the NHIA Claims Directorate is working on a Claims Resource Portal to enhance transparency and communication between healthcare providers and the NHIA.
Dr. Derkyi-Kwarteng disclosed that the portal will allow providers to track the status of their claims in real time, ensuring they have visibility into whether their claims have been submitted, are under review, or have been paid.
“For instance, a provider can log in and check the status of their December 2024 claims. The portal will provide real-time updates, indicating whether the claim has been submitted, is pending, or has been paid. This will resolve a common concern among providers who often struggle to verify which claims have been processed,” she explained.
The portal will also provide a platform for providers to report challenges they encounter, ensuring prompt resolutions and strengthening communication with the NHIA.
Dr. Derkyi-Kwarteng acknowledged the contributions of healthcare providers in delivering quality healthcare services and assured them that the NHIA remains committed to addressing their concerns to support the goal of achieving universal health coverage.
Source – NHIA PR Unit
