Amplify Health leverages AI to transform medical claims adjudication for Asia's health insurers

The company uncovers hidden claim leakage with AI-enabled clinical enrichment and FWA detection.

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Affordable health coverage in Asia is facing an uncertain future: health insurers are increasingly hiking premiums as they grapple with rising medical costs. Amidst growing claim volumes, many insurers struggle to detect Fraud, Waste, and Abuse (FWA) in medical claims they receive - such as overcharging, overservicing, and procedure-diagnosis mismatches - because their claims systems are capturing only high-level claims header data. But now, Amplify Health is enabling insurers to capture every single line item they are billed and pinpoint suspicious charges in a highly targeted way, with an integrated health intelligence solution that has won most innovative AI solution for heath insurance at the SBR Technology Excellence Awards.

Building a structured data foundation

Within many Asian markets, medical claim invoices vary widely in their fees, formats, level of detail, and clinical terminology used. This makes it challenging for insurers to understand the medical context for various claim lines, compare similar claim items over time and across providers, and identify suspicious claim patterns.