— Building an Intelligent Closed-Loop System from Enrollment to Claims
Introduction: Medical Insurance Can No Longer Rely on Manual Oversight and Paperwork
Traditional medical insurance services rely heavily on manual processes and paperwork—from risk notification, policy enrollment, claim initiation to settlement—resulting in inefficiencies, delays, and poor user experience. Hospitals, being high-intensity, high-complexity information environments, require strong digital capabilities to achieve process coordination, data integration, and automation. Yihuibao leverages digital tools to create a closed-loop system that spans the full insurance life cycle, improving both efficiency and data-driven risk management.
I. Starting from Enrollment: Achieving Paperless and Intelligent Access
Yihuibao offers a 'scan-to-enroll' solution fully synchronized with preoperative consultation processes:
- Scan to access platform: Patients enter the mini program by scanning a QR code, no app download needed.
- Smart ID recognition: Auto-matching patient information via medical insurance card or admission number.
- Online risk education: Animated videos explain risk scenarios, encouraging policy purchase.
- Real-time e-signature: Patients confirm consent and sign policies electronically.
II. Fast Event Reporting System for Improved Claims Response
- Integration with HIS: Trigger alerts for events like excessive bleeding, ICU transfers, or DVT-positive results.
- Auto-match policyholders: System detects whether patient is insured.
- Onsite follow-up: Insurance staff receive alerts and quickly follow up for documentation.
- Data loop closure: All flagged cases are recorded and analyzed.
III. Intelligent Claims Review Platform
- EMR keyword detection: Extracts key procedure and complication info.
- Rule automation: Matches case data to insurer-specific rules.
- Compensation suggestion: Based on case complexity and stay duration.
- Progress visibility: Patients can track claims in the app.
IV. Operational Dashboard and Risk Heatmaps
- Real-time coverage: View coverage penetration and trends.
- Case cycle tracking: Analyze delays and efficiency.
- Risk heatmaps: Visualize complication hotspots by department.
- Feedback scores: Aggregate patient ratings for quality improvement.
Conclusion: Digitally Driven Insurance Services Are Faster and More Reliable
Scenario-based insurance relies on digital infrastructure to deliver real value. Yihuibao will continue enhancing its platform to provide a seamless, intelligent, and scalable service experience for patients, hospitals, and insurers.