Digitalization TF for Real Loss Claims Officially Launched: "Prioritizing System Construction Work"

TF Full-scale Operation... Monthly Regular Meetings Held

A task force (TF) for the digitization of claims for indemnity health insurance has been officially launched. Preliminary work for building the electronic system will be expedited, and various detailed matters will be decided.

On the 7th, the Financial Services Commission announced that it held a 'Indemnity Insurance Claims Digitization TF' meeting together with related agencies such as the Ministry of Health and Welfare, and made this decision. At the meeting, they reviewed the necessary matters to smoothly implement the digitization of indemnity insurance claims in accordance with the amended Insurance Business Act promulgated on the 24th of last month, and discussed the future direction of the project.

The amended Insurance Business Act includes provisions to establish a computerized system that automatically files indemnity health insurance claims after medical treatment. Until now, to claim indemnity insurance benefits, patients had to obtain paper documents from hospitals, clinics, or pharmacies and submit them to insurance companies. The insurance companies then manually entered this information into their systems before paying the customers. The goal is to fully digitize this process so that patients can pay medical fees at the hospital and immediately file indemnity insurance claims.

The TF decided to expedite preliminary work on building the electronic system while revising the enforcement decree to select an agency responsible for transmitting such claim information. This is because hospital-level medical institutions (with 30 or more beds) must comply starting October 25 of next year. Accordingly, detailed matters necessary for building the electronic system?such as insurance claim procedures, standardization of claim forms, and authentication and security measures for information transmission?will be finalized through consultations with stakeholders, and specific system development will proceed.

The TF has established three working groups under its umbrella?▲Regulation Revision ▲Electronic System Construction ▲Electronic System Deployment?to handle practical matters, and will report major discussion points and decisions to the TF. TF meetings will be held regularly once a month, with additional meetings convened as needed.

A Financial Services Commission official explained, "Although various opinions may be expressed among stakeholders during the process of promoting the digitization of indemnity insurance claims, participants at this meeting agreed to actively discuss the matter with the goal of enhancing public convenience and reducing medical expenses."

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