the most interesting things for the second half of 2024
Global Overtreatment
Accuracy of the solutions related to medication for outpatient cases has increased to
98%
Patient age groups specified to a month for under one-year olds, with new validations introduced for dosages, treatment duration, and vaccination period
Automation solution developed to comply with the new KSA regulatory requirements for the PBM process
unique ICD-10 codes updated in accordance with the current local and international guidelines
>350
The average overtreatment rate for clients in 2024 averaged
20%
insurance companies in the KSA and Bahrain use the Overtreatment product by Mains Lab, with 6 of them utilizing more than one MainsLab solution
8
Overtreatment Russia
out of the Top-10 insurance companies in Russia use the Mains Lab Overtreatment product
6
of all VHI medical bills in the Russian market are reviewed monthly through Mains Lab's solution
80%
210
million rubles in discrepancies were found after processing
5,2
billion rubles worth of claims
unique ICD-10 codes have been added and updated according to current local clinical guidelines
>1000
MainsLab has launched an improved medical service classifier – MeMas
The claim
No
100 000
was uploaded into the system in December 2024
Recommendation confidence levels and service frequency are added for display in the MainsLab interface based on regulatory acts
"Green Corridor" is implemented – an AI-powered claim review process without expert involvement is now part of the solution
Our solution was directly integrated with the medical fraud detection product
out of the Top-10 insurance companies in Russia use the Mains Lab Overtreatment product
6
of all VHI medical bills in the Russian market are reviewed monthly through Mains Lab's solution
80%
210
million rubles in discrepancies were found after processing
5,2
billion rubles worth of claims
unique ICD-10 codes have been added and updated according to current local clinical guidelines
>1000
Recommendation confidence levels and service frequency are added for display in the MainsLab interface based on regulatory acts
MainsLab has launched an improved medical service classifier – MeMas.
"Green Corridor" is implemented – an AI-powered claim review process without expert involvement is now part of the solution
The claim
No
was uploaded into the system in December 2024
100 000
Our solution was directly integrated with the medical fraud detection product
Fraud, Waste and Abuse Russia
3
out of the Top-10 clients in Russia will be using the FWA service in 2025
A universal dashboard designed for a comprehensive Clinic Profile
A new benchmarking feature created to analyze the frequency and recurrence of services across all medical specialties
The solution has identified potential fraud and abuse in VHI worth
>100
million rubles
Global
Fraud, Waste and Abuse
Brand new BI interface designed
A feature developed for detecting anomalies in average claim payouts
Contracts signed and projects launched with three new clients:
2
clients in Saudi Arabia
1
client in Bahrain
The total amount of reviewed claims:
>800
million $
preliminary contracts secured in Saudi Arabia and Bahrain
5
Saudi Arabia
Bahrain
Solution “Second” Russia
Claim calculation processing for requests submitted via mobile app now launched by MainsLab with a Top-3 client
Valuation models implemented for the most popular Chinese car brands
(now covering 20+ new models)
out of the Top-10 insurance companies in Russia use the Mains Lab Second product
6
growth in urgent requests
150%
>10 000
claims are reviewed monthly
claims per month
Increased adoption of our new CASCO claims settlement solution: calculation and repair appraisal processing now handle
>1000
Underwriting Russia
Data validation and cleansing methodology enhanced with the expanded list of clues to detect hidden check-ups and medical screenings
Analytical report specially designed for monitoring key service KPIs for corporate clients, powered by LLM models that analyze insured individuals' behavior and their service approval requests
UW Solution’s Distribution model enhanced with a new feature for access types in medical facilities
The solution has processed
~600
VHI tenders from large corporate clients
totaling
>12
billion rubles
Clinics Russia
Launched an informational Telegram channel, where weekly case studies on VHI are analyzed
Following topics covered in the webinars:
- Main types of services that are featured in VHI billing;
- Insurance contracts in the VHI sector – important nuances;
- Pediatrics and VHI – key things to note;
- How VHI works in "Zetta Insurance";
- Planned changes in clinical guidelines starting in 2025.
5
webinars conducted for over 50 participating clinics
Personal Accounts
Integration with Sber upgraded to a new API version without RBS
Personal Accounts now comply with the Ministry of Digital Development requirements for data transmission to ORM
The stories service launched, powered by InAppStory
The feature launched for facilitating collective requests
A new push notification system implemented for policyholders
