IRISCAN

Solutions · Health insurance

Pay only for verified visits of real members

Biometric member enrollment and verification at the point of care for national health insurance schemes and private insurers, so the scheme pays for real visits of real members.

Discuss your scheme Read: lessons from Ghana and Kenya

The problem

How does an insurer know that the patient in a clinic is the member on the card, or that the patient came at all? A membership card proves only that someone holds it. Cards are lent to relatives, claims are filed for visits that never took place, and the insurer finds out months later, if ever. In schemes that cover millions of people, these losses decide whether the scheme is sustainable.

5–10%of claim costs estimated as fraudulent claims by providers in Ghana's national schemeOwusu-Oware, Effah, Boateng, AMCIS 2018
15–16%fewer claims after biometric verification was introduced in Ghana, as estimated by an NHIA officialGhana's experience, AMCIS 2018
1 dayclaims processing with LCT Africa's fingerprint authentication at Kenyan hospitals, down from four monthsBiometric Update, LCT Africa

What you get

Member enrollment without documents

Members and their dependants are enrolled once with iris, face or fingerprint. The system checks that the person is not already registered under another number, so a second membership for the same person is flagged before it is issued.

Verification at the point of care

The clinic scans the member at the visit, and the verified encounter is attached to the claim. This is the step where borrowed cards and phantom visits are stopped.

Works where the internet does not

Rugged tablets and USB scanners with the Edge service keep verifying offline and synchronize when the connection is back. Existing smart cards are still supported.

Integration with claims systems

Verification results go into your claims management or e-claims platform over an API, so the payment rule becomes simple: verified encounters are paid, the rest are reviewed.

Biometric check at the point of care: enroll, visit, claim, pay
The biometric check happens at the visit, and the claim carries its result.

Why iris

Health insurance covers the elderly, children and manual workers, exactly the people whose fingerprints are worn or not yet formed. Iris capture is contactless, which matters in a clinic, and it separates people well enough to de-duplicate a national member register. Where a fingerprint infrastructure already exists, we add iris as a second modality instead of replacing it.

Deployment

Hardware

USB iris scanners from €139 for clinics with a PC, rugged BIOSID tablets with fingerprint, iris, face and smart card reading for field enrollment and rural facilities.

Where the data lives

On your servers or in a national data center, with biometric images in ISO formats. Biometric data is stored apart from medical and personal records, encrypted and pseudonymized.

How we start

We recommend starting with a pilot in a group of facilities with the highest claim volumes. Members are enrolled at their next visit, and for a few months claims from these facilities are compared with a control group. This way you measure the effect on your own data before a national rollout.