Medi Assist processed 1.02 million platform claims in H1

Medi Assist processed 1.02 million retail claims on its platform in H1FY27, up 917.9% year on year, as seven insurers contracted for its technology. Three insurers were live during the half year and four were due to go live in H2FY27, while platform premiums reached Rs 9,648 crore.

How large is Medi Assist’s insurer technology platform?

Medi Assist’s technology business generated Rs 18.1 crore of revenue in H1FY27, a year-on-year increase of 83.8%, and accounted for 3.79% of revenue, up 146 basis points. In Q2FY27, technology revenue was Rs 10.4 crore, up 112.6% year on year.

The platform handled about 7 million claims in H1FY27 across third-party administrator, platform and international operations. The 1.02 million retail-platform claims figure is narrower, covering claims reported under the retail segment’s platform measure rather than the combined MAtrix total.

Platform premiums were Rs 9,648 crore in H1FY27, up 24.8% year on year. This premium measure was substantially larger than the Rs 18.1 crore technology revenue reported for the period, as the presentation reports premiums managed or supported on the platform separately from fee revenue.

Which insurers are using Medi Assist technology?

Seven insurers had contracted for Medi Assist technology by H1FY27, of which three were live and four were scheduled to go live in H2FY27. Medi Assist said that more than about 95% of the live insurers’ inpatient claims already ran on MAtrix, its core claims platform.

Contracted platform premium was about Rs 758 crore from two insurers. The presentation also states that two new-age insurers using the platform were still building their books, while the four remaining contracted insurers were scheduled for H2FY27 launches.

Medi Assist offers insurers a full-stack deployment, the core platform, or an artificial intelligence, or AI, layer alone. Its Network as a Service, or NaaS, product was used by 19 insurers for access to its hospital network and tariffs, allowing insurers to use network and tariff functions as a separate service.

How does platform growth compare with retail TPA activity?

Platform activity expanded while Medi Assist’s retail third-party administrator, or TPA, measures declined in H1FY27. Retail TPA revenue was Rs 45.5 crore, down 1.8% year on year, and retail TPA premiums managed were Rs 1,164 crore, down 8.5%, compared with 24.8% growth in platform premiums to Rs 9,648 crore.

Retail TPA revenue share was 9.5%, down 144 basis points year on year. Retail market share was 3.7% for TPA activity alone, down 162 basis points, while the reported TPA-plus-platform retail share was 34.1%, down 331 basis points.

The presentation identifies retail as 44% of India’s health premium and says the segment grew twice as fast as group insurance in H1. Medi Assist describes its two delivery routes as acting as an insurer’s TPA or supplying the technology used by the insurer’s own service operation.

The group operation remained materially larger in the reported half year. Group revenue rose 13.7% to Rs 334.7 crore and group premiums managed increased 21.8% to Rs 13,939 crore, while group-health premium market share reached 34.1%, up 182 basis points.

How do MAtrix and AI tools process insurance claims?

MAtrix applies policy terms, clinical protocols and hospital tariffs to claims, while NaaS attaches the agreed tariff at the time of a claim. Medi Assist reported about 1 million MAtrix claims processed each month, or about 7 million claims in H1FY27 across TPA, platform and international activity.

MAvEn IDP, Medi Assist’s document-processing AI product, reviewed more than 10,000 claims a day, with more than 99% reviewed within 15 minutes. The company also reported more than 45% straight-through pre-authorisations, a measure of pre-authorisations passing through the stated automated workflow.

MAvEn Guard scores every claim across more than 200 data points for fraud, waste and abuse, or FWA. Medi Assist reported Rs 304 crore of FWA savings in H1FY27, up 32.2% year on year, and said 85% of those savings were AI-led.

The Rs 304 crore technology-wide FWA figure differs from the approximately Rs 246 crore fraud-savings measure reported in the group segment for H1FY27. The presentation reports the former under MAvEn Guard’s platform proof points and the latter as a group-segment operating metric.

What controls does Medi Assist describe for its AI products?

Medi Assist says its fraud score is an input for claims processors rather than a black-box decision. It says every flag contains evidence-based reasons that a reviewer can check, while decisions carry reason codes and a log of the rules applied.

The company says investigator outcomes retrain its models and that it monitors error rates across demographic segments to identify bias. It also says personal data is automatically detected and redacted, alongside the more than 10,000 daily claims reviewed by MAvEn IDP.

Medi Assist also uses technology for the member discharge process through Raksha Prime, which simulates hospital bills and estimates out-of-pocket costs before discharge. The company reported 1.89 lakh bill-free, zero-wait discharges in H1FY26, up 21.2% year on year.

Conclusion

Medi Assist’s H1FY27 results show technology deployment expanding alongside its established claims-administration operations. Retail platform claims reached 1.02 million, platform premiums rose 24.8% to Rs 9,648 crore and technology revenue increased 83.8% to Rs 18.1 crore, even as retail TPA revenue declined 1.8%.

The next disclosed development is the planned H2FY27 launch of four contracted insurers after three were live in H1FY27. The presentation also identifies about Rs 758 crore of contracted platform premium from two insurers, providing a measure to watch as insurers launch and their books develop.