The Korea Insurance Development Institute has been finally selected as the medical data transmission agency (intermediary agency), which is the core of the simplified claims service for indemnity insurance.
On the 15th, the Financial Services Commission held a task force (TF) meeting on the computerization of indemnity insurance claims and confirmed this decision. There had been intense tensions between the insurance industry and the medical community over the selection of the intermediary agency. The insurance industry insisted that the Korea Insurance Development Institute be selected, while the medical community argued for a private fintech company as the intermediary agency, escalating the conflict. Eventually, the medical community stepped back, resolving the dispute.
This selection of the intermediary agency is a follow-up measure after the amendment to the Insurance Business Act passed the National Assembly last October. The amendment focuses on simplifying indemnity insurance claims by electronically transmitting insurance claim documents from medical institutions (hospitals, clinics, pharmacies) to insurance companies upon the consumer's request. Hospitals with 30 or more beds will implement this from October 25 this year, and clinics and pharmacies from October 25 next year.
Heo Chang-eon, President of the Korea Insurance Development Institute, is speaking at the '2024 New Year Press Conference' held on the 1st.
The current method of indemnity insurance claims using fintech, which is being implemented in some hospitals, will be maintained as is.
The committee to discuss matters related to the construction and operation of the computer system will consist of up to 20 members, with an equal number of members recommended by the medical and pharmaceutical sectors and the insurance industry to maintain balance. The committee will carry out tasks such as consultation and coordination among stakeholders, as well as recommendations and evaluations related to the duties of the transmission agency.
The documents eligible for electronic claims are limited to those that medical institutions are currently obligated to provide to insurance policyholders, such as invoices/receipts, detailed statements of charges, and prescriptions.
The Financial Services Commission plans to announce the amendment to the Enforcement Decree of the Insurance Business Act, which includes these details, for public comment within this month.
A Financial Services Commission official stated, "We plan to continue discussions with various stakeholders, including the medical and insurance sectors, through the 'Indemnity Insurance Claims Computerization TF' on various matters such as the establishment of a simplified claims system and measures to prevent disputes between insurance consumers and medical institutions. We will make multifaceted efforts to ensure the smooth progress of the simplification of indemnity insurance claims to enhance public convenience."
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