Kata Kunci

Abstrak

An efficient medical claims billing system is critical to mitigating the challenges associated with claim denials and ensuring the sustainability of providing healthcare services. 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. Methods 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. The claim rejection rate was estimated for each month. 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. We employed meta-analysis techniques to generate a pooled impact estimate of DHT systems on the claim rejection rate of health insurance claims. Results 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%). 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. Conclusion The DHT recorded lower denied claims costs than the paper-based claims system. Scaling up the use of DHT for claims submission will reduce the rate of claim denials and ensure the sustainability of providing healthcare services.