Ingosstrakh together with Mains Lab introduced AI in the process of coordinating services for VMS

2022: Implementation of AI in the process of harmonizing services for LCA

SPAO Ingosstrakh, together with the MAINS Lab team, on March 9, 2022 announced the introduction of artificial intelligence in the process of coordinating voluntary health insurance services for company customers.

Thus, Ingosstrakh decided to accelerate the process of coordinating medical services, aiming to increase the speed and objectivity of the process of coordinating procedures for insured.

Ingosstrakh constantly develops the level of care for customers and develops services so that everyone, in collaboration with the company, feels confident and protected.

To do this, the company used software based on the MAINS Lab product, which made it possible to process requests for service coordination at a completely different level, both in terms of speed and control of correctness of decisions. This software includes two modules: the first unifies the text of the clinic's request, brings the name of the services to the standard type and recognizes the diagnosis codes, and the second analyzes the requested services from the point of view of existing regulations (medical and economic standards of the Ministry of Health of the Russian Federation and clinical recommendations) and the filling of the patient's insurance program.

Ingosstrakh has always paid special attention to the quality and innovation of the customer service that we provide to our insured under VMS, and the coordination of medical services under warranty letters has always been a very important object in the client path between customers and the insurance company. I am sure that the initiative to introduce artificial intelligence in the process of coordinating services will strengthen the position of our company in the quality of service in the DMS market Russia - said Dmitry Popov, Deputy General Director for DMS Ingosstrakh.

The complexity of insurance programs, their variability and the number of requests from clinics, as well as the growth of their volumes with the growth of the VHI portfolio, puts forward very high requirements for specialists of insurance companies that work in this area. Obviously, without automating the process of harmonizing services, customers, insurance companies and clinics will incur high costs. That is why Ingosstrakh decided to accelerate this process for the convenience of our customers, "said Anastasia Skurikhina, head of the Ingosstrakh VMS client service.

The accelerated process of coordinating medical services by insurance companies has long been waiting for its hour to set up automation. All the accumulated technologies in terms of processing natural languages ​ ​ in medicine, a library of rules and algorithms that check medical services for compliance with clinical recommendations, insurance programs and contractual conditions - all this made it possible to introduce a solution for Ingosstrakh customers in the shortest possible time, "said Yuri Kuvshinov, General Director of MAINS Lab.

According to Ingosstrakh, the coordination of medical services by insurance companies requires an average of 30-35% of all services provided under VHI programs. The approval process takes up to 30 minutes on average, and service decisions are not always transparent and synchronized enough, which causes discontent from doctors and customers.

2020: Automation of Tenders Processing Process

Insurance The SPAO Ingosstrakh company "" and the developer IT of solutions based on artificial intelligence Mains Lab December 4, 2020 summed up the results of the project to automate the process of processing tenders according to (VHI voluntary). to medical to insurance

More than a year ago, Ingosstrakh and Mains Lab launched a project aimed at accelerating and simplifying the process of working with tenders for DMS. The main driver of automation was the use of fuzzy search technology, which made it possible to compare the requirements of the corporate client for the coverage and composition of clinics in the VHI program and the capabilities of the insurance company - the presence of contractual relations with clinics and the risks covered in them. Over the past 12 months, the project has worked out more than 250 tenders containing more than 300 thousand combinations of various names of clinics and amounts of assistance. The results were the acceleration of the process of pre-processing tenders by 3 times (from 3 to 1 day). The companies agreed to extend the project for the next year, since the achieved effect is fully consistent with the company's strategy for automating business processes.

Sales Director of the Ingosstrakh Medical Insurance Department Dmitry Gorbunov believes that the key result will be "a qualitative improvement in the development of tenders, since accelerating the process of recognizing the tender gives us the opportunity to spend more time improving the quality of our offer for each new corporate customer for VMS."

Mains Lab CEO Yuri Kuvshinov noted that "the key success factor was the availability of experience in introducing similar projects in other insurance companies. A database of synonyms, accounting for the historicity of the names of clinics, constant training on new data allows you to constantly accelerate the process and achieve a quality close to 100%. "