![]() The bureaucratic nature of claims reimbursement processes to providers results in an uncompensated claim due to claim errors and other administrative reasons. This widespread canker is not just time-consuming rework but also a delayed or lost revenue and put pressure on scarce resources. Claim denial has the potential to prevent any healthcare provider from being on track. The ability to prevent claim denial before the health insurance claim is submitted to the insurers will increase profits, enhance the revenue cycle positively, and supports the general wellbeing of patients. estimated that adjusted paper-based claims due to errors in claims cost GHS2.81 million representing 4.9% of total reviewed claims of GHS57.50 million (USD15.09 million) to the healthcare provider. Health insurance claim denials, also known as ‘claim denial hereafter’ are one of the pivotal contributors to the ever-increasing billing and insurance-related costs (BIR). In 2017 alone, the recovery cost is estimated as high as $120 per health insurance claim in the United States and is considered to be a waste within the US healthcare system. identifying reasons for the denial and errors, correcting the errors, and resubmitting them for reimbursement) on healthcare providers. In addition, the denial of claims puts a cost burden such as cost recovery (i.e. Health insurance companies reject 14% of healthcare providers’ claims, amounting to US$262 billion annually. In 2014, WHO estimated that cost of fraud and incorrect payments in the world’s healthcare systems is about 7% of total global health expenditure, or US$487 billion. World Health Organisation (WHO) describes medical billing errors and healthcare fraud as ‘the last great unreduced healthcare cost’. The implementation of health insurance schemes is at different stages across the globe, especially in developing countries with the primary goal of giving citizens high access to healthcare. Scaling up the use of DHT for claims submission will reduce the rate of claim denials and ensure the sustainability of providing healthcare services. The DHT recorded lower denied claims costs than the paper-based claims system. DHT contributed to an immediate impact of 1.31 percentage point reduction in the claim rejection rate of health insurance claims compared to the paper-based system. The total cost of deductions due to errors from the DHT system was significantly lower than the paper-based system (DHT = 8.15%, paper-based system = 10.13%). We employed meta-analysis techniques to generate a pooled impact estimate of DHT systems on the claim rejection rate of health insurance claims. Prais-Winsten Segmented Interrupted Time-Series analysis was used to estimate the impact of DHT systems by comparing claims data before and after the system implementation for each facility. The claim rejection rate was estimated for each month. The study used longitudinal data on monthly claims adjustments due to errors from both paper-based and claims submitted using different DHT systems from 2010 to 2019. ![]() This study assessed the impact of Digital Health Technology (DHT) in reducing the claim rejection rate of health insurance claims submitted by health facilities to the National Health Insurance Authority in Ghana. An efficient medical claims billing system is critical to mitigating the challenges associated with claim denials and ensuring the sustainability of providing healthcare services.
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