Insurance claim first-pass rate from 61% to 92%
Afya Health Group — MediClinic Records
Before and after
- First-pass claim acceptance
- 61%92%
- Average patient wait
- 48 min21 min
- Patient files across branches
- 6 sets1 record
- Month-end reconciliation
- 5 daysInstant
The situation
Afya Health Group's revenue problem looked like a billing problem but was a documentation problem. Claims were rejected because clinical notes taken on paper did not contain what insurers required, and by the time rejections arrived the patient was long gone.
What we built
A shared electronic records platform with patient history, prescriptions, lab results, billing and insurance claim generation - built around clinical workflow rather than an accounting model.
Appointment confirmed, Thu 14 Mar 10:30, Westlands branch. Reply 1 to reschedule. Records synced across all 6 branches.
What it changed
- Claims are now generated from structured clinical data captured during the consultation
- Patients moving between branches arrive with their full history already present
- Month-end reconciliation dropped from a week of manual work to a generated report
- Wait times halved, which lifted daily patient throughput without adding staff
Our claim rejection rate was the quiet thing bleeding us. Fixing the documentation at the point of care fixed the revenue.
Commercials
- Investment
- KES 4.4M over 20 weeks
- Payback
- Recovered claim revenue exceeded the build cost within the first year
- Delivery
- 20 weeks
Technology
- Next.js
- Node.js
- PostgreSQL
- Docker
- AWS
Tell us what is not working
Thirty minutes, no deck. You will leave with an honest read on feasibility, a price band and a timeline - whether or not you work with us.
We reply within one business day.