NHIS to deploy Artificial Intelligence to improve audit of claims

The National Health Insurance Scheme (NHIS) is introducing an advanced artificial intelligence (AI) system to enhance claims auditing.

The AI technology will identify outliers in real-time, ensuring accuracy and efficiency.

This innovation aims to address issues such as unauthorized services, illegal charges, fraud, and quality of care problems.

The NHIS has 30 million enrolled members, 5,232 facilities, and 4 million health service providers.

The scheme is intensifying clinical and compliance audits and stakeholder engagement to improve service delivery and maintain the integrity of the health insurance system.