Medical Insurance Direct-Billing Claim Case Analysis

Insurance claims are getting more and more attention from regulators.Regulators have repeatedly issued documents requesting improvement of insurance claims services.However,at present,China's commercial medical insurance claims only make up a small portion of direct payment claims.Commercial medical insurance claims mainly use long claims periods.Pay-back claims,this backward claim method cannot meet the needs of insurance consumers for real-time settlement of medical expenses.At the same time,insurance technology has also begun to gradually shift from the underwriting end to the claims end.Technical support for direct payment It is relatively mature.Analyzing and solving the current dilemma combined with the actual situation of direct payment claims by specific insurance companies is of great significance to the promotion of direct payment claims for commercial medical insurance.This article takes TK Life Tianjin Branch's medical insurance direct payment claims as a case.Firstly,it introduces in detail the three aspects of the insurer's demand for commercial medical insurance claims,the regulatory attitude on claims,and the APPlication of insurance technology to the claims The background of commercial medical insurance direct payment claims,followed by a comprehensive introduction to the meaning,characteristics and process of direct payment claims.Based on this,combined with the data since the introduction of direct payment claims by TK Life Tianjin Branch,from TK Life Tianjin Branch's direct payment claim cooperation model status,docking status and compensation status analysis of TK Life Tianjin Branch's direct payment claim operation,and found that TK Life Tianjin Branch's direct payment claim operation process exists.The hospital's cooperation intention is not high,it is difficult to interface with the hospital information system,excessive medical treatment,and the insured does not cooperate with the report.Finally,referring to the excellent claims settlement experience at home and abroad,combined with the current problems of TK Life Insurance Tianjin Branch's direct payment claim settlement,it proposes targeted suggestions from the four aspects of changing cooperation partners,using third-party platform management,establishing internal and external reward and punishment mechanisms,and publicity methods.To provide a reference for insurance companies to promote direct payment of medical insurance claims.