Background

Egypt’s Health Insurance Organization (HIO) is a governmental organization in charge of Egypt’s Public Health Insurance. The HIO provides medical coverage and services to beneficiaries all over Egypt, operating through its branches and hospitals from Alexandria to Aswan.

Problem

Prior to automation, the HIO used manual paperwork to process and transfer medical claim approvals from 27 governorates, which can take up to 28 days from time of submission to time of approval. Being manually driven, the process was prone to a high degree of human errors which was slowing down the processing time and hindering operational quality.
Aiming to improve the efficiency and accuracy of the manual workflow, Everest Minds was appointed to deliver a Digital Medical Insurance System to enhance the efficiency and accuracy of the current workflow.

Solution

Built on top of our Sherpa Workflow Automation Studio; a comprehensive workflow automation and management tool, Everest Minds designed and implemented a streamlined workflow solution “iClaim” that managed to deliver an efficiency improvement of 90% from an average claim approval time of 28 days to a maximum of 3 days. In addition, the digital claim submissions resulted in an accuracy improvement of 100%.

Moreover, with the advent of iClaim, the HIO is able to have full control of the process tracking and monitoring claim submissions in real-time, as well as access to real-time data analytics which aids decision making.

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