New entrant to the group health and life insurance market, Canopy Insurance Limited, has partnered with technology firm Advanced Integrated Systems (AIS) to utilise its Provider Access System (PAS) that undertakes online, real time insurance claims adjudication.

Two weeks ago, GraceKennedy and the Musson Group announced a partnership that will see the two companies collaborating to enter the group health and life insurance market under the name Canopy Insurance Limited.

With the official start of the partnership between Canopy and AIS, the new insurance company has begun to recruit medical professionals to join its network.

“Canopy aims to deliver a hassle-free health insurance experience at every point of contact,” Sean Scott , CEO of Canopy Insurance Ltd, said via news release.

“This starts with making the claims process as frictionless as possible for the medical community. We chose AIS to ensure that Canopy claims would be seamlessly integrated into the medical community’s existing workflow, without the need for additional expenditure or new processes to learn.”

According to Douglas Halsall, chairman of AIS, Jamaica, is ahead of most countries and certainly the United States when it comes to online real time insurance adjudication.

“Years ago we examined the market and realised the difficulties evident in the continued use of paper claims,” Halsall said. “When mostly paper claims were used, there was no way of telling whether a patient has exhausted his/her insurance benefits. To fix the inefficiencies, we began the process of digitising the health insurance industry, allowing providers to submit claims online in real time, improving efficiency for the health insurance companies and providers, and increasing access for patients. So we started on the Provider Access System (PAS),”

PAS is a flexible, online, real time health benefit management and provider claims settlement system.

The provider — doctor, dentist, ophthalmologist, radiologist/lab, hospital, etc — simply installs the software, a swipe device for the health cards and a printer for receipts, and claims can be adjudicated in real time with payments guaranteed.

The system gives an immediate response, ensuring that the provider benefits by always accessing his/her payments.

The PAS offerings continue to improve over time, as they are now capable of covering drug interactions, patient profiling, e-prescriptions, drug monographs, patient education leaflets, and drug registration and information dissemination.

“Today we can proudly say that we have nearly 4000 providers — including, doctors, dentists, pharmacies and labs — who use this system to process insurance claims. In fact, most of our clients have also had good things to say about us and refer others to use our system,” Halsall said.

The National Health Fund has been using PAS as part of its benefits programme since its inception more than 15 years ago.

US-based insurance consultant Larry Thompson did a comparative analysis of PAS and the US systems. He stated that the process being used in Jamaica is far more efficient and cost-effective, according to the press release. Thompson said that Jamaica’s health insurance adjudication system is “more timely, reasonable and efficient than any such service offered in the USA. At roughly 50 per cent of what providers pay to the bank for credit card processing fees and less than charges in the USA with more guarantees, it’s a win for all stakeholders — patients, carriers and providers.”

The AIS online realtime insurance adjudication system has been in use by major insurance companies in Jamaica since 2000. Locally, the PAS has already been implemented by Guardian Insurance and Sagicor in the daily execution of their claims processing.

Canopy will commence formal operations in the second half of 2019, fully equipped with PAS.