A cheaper claims rail opens up operating tools for local clinics

The claims button has already moved into everyday apps

The digitalisation of indemnity health insurance claims began at hospitals and public health centres in October 2024, then expanded to clinics and pharmacies in October 2025. Patients can select a hospital and treatment date, then request a claim through not only Silson24 (실손24), Korea’s shared electronic route for sending medical documents to insurers at a patient’s request, but also Naver Map, Naver Pay, and Toss.

The three standard documents sent by medical institutions are a medical bill and receipt, an itemised statement of medical charges, and a prescription. For documents an insurer may request in addition—such as a medical certificate or surgery confirmation—the patient may need to upload them separately or obtain them separately from the clinic.

As of September 28, 2026, 50,340 of Korea’s 105,643 medical institutions were connected to Silson24. The overall connection rate was 47.7%, while the rate for second-stage institutions, which combine clinics and pharmacies, was 46.7%. The scheme now covers all clinics, but only about half can actually process claims.

At the same point, Silson24 had about 5.21 million registered users and about 4.61 million cumulative electronic claims. The expected connection coverage, including institutions using participating electronic medical record programmes, was 96.1%, but that was about twice the actual completed connection rate. Patient-facing claim routes have expanded quickly, while many final clinic-side settings remain unfinished.

A clinic must first check whether its electronic medical record programme—which manages clinical records and billing—supports Silson24, then complete consent, a connection application, and a test transmission. It is difficult to state a uniform installation or maintenance cost for Korean clinics. In a survey cited by Korea’s Financial Services Commission, 67% of participating hospitals said their administrative burden for issuing documents had decreased.

What remains at a two-doctor internal medicine clinic

Take an operating assumption: Ms Kim is the administrative manager at an internal medicine clinic on the outskirts of Seoul, with two doctors and three administrative staff. The clinic is eligible for Silson24, but has either delayed its connection application or only recently completed the connection.

When a patient asks at reception whether an indemnity insurance claim is available, Ms Kim first checks whether the clinic appears in search. If it is not connected, she explains that the patient must obtain documents under the previous process and submit them through an insurer’s app or website. If it is connected, she explains which app lets the patient find the hospital and treatment date.

The problem is that “claim failure” can mean several different things. A clinic not appearing in search, a hospital appearing but no treatment record showing, and an insurer requesting additional documents or holding payment after transmission all arrive at Ms Kim’s desk. She has to note the error message and treatment date, then decide again whether to send the issue to the software provider, Silson24, or the insurer.

A connection-preparation tool could first ask for the clinic’s programme name and version, medical institution identifier, and contact person in sequence. It could show support status and where to apply, then produce a one-page list of installation-cost, authentication, and test-transmission questions to ask the provider. Rather than declaring a nationwide standard list of paper documents, it is better to keep updated records of the documents each provider actually requires.

After connection, enquiries can be split into three paths. The clinic and Silson24 check hospital and treatment-record lookup problems; the insurer handles submission, review, and payment issues after transmission; and the clinic reception desk handles the issue of additional medical certificates. Recording only the error time, message, responsible organisation, and response status on one screen can reduce repeated copying of the same information.

What has become cheaper here is the transmission rail, not insurance decisions or the preparation of medical documents. Instead of building a new claims network, a builder can add small functions—application checks, staff response guidance, and error records—on top of existing Silson24 and consumer apps. This reduces the need to build a large system that connects both insurers and clinics from the start.

Some work still requires people. Clinic staff must verify that clinical records are correct, issue additional documents, and avoid promising an insurance payout to patients. The buyer for this type of service is therefore closer to an administrative manager such as Ms Kim than to the patient.

Overseas examples make operations easier than transmission

Canada’s TELUS Health eClaims helps medical providers such as physiotherapists and massage therapists register online for free and submit claims directly to insurers. Without installing separate equipment, providers can check a patient’s coverage, after which the patient pays only the amount not covered by insurance at the point of care.

TELUS says more than 100,000 healthcare professionals use the service. It also says 94% of users would recommend it to a colleague, though this is a company-run survey. The model gathers users through free transmission and connects insurers with medical providers.

Australia’s Tyro Health offers private insurance claim submission for free and earns separate revenue from card payments or payment terminals. Providers can register a provider number online, then handle insurance claims and patient out-of-pocket payments in sequence.

In a Pinnacle Health Group case published by Tyro, Medicare claims that previously took two to five minutes fell to under 10 seconds after connection to a practice-management programme. It is a single customer case published by the supplier, but it shows that the value may lie less in transmission fees than in reducing the time staff spend re-entering the same information.

France’s electronic care sheet system sends treatment-cost data to public health insurance using a patient’s health insurance card and a provider’s software. According to France’s Health Insurance system, the administrative cost of an electronic care sheet is EUR 0.27 per claim, about KRW 400, versus EUR 1.74, about KRW 2,600, for a paper care sheet—a reduction of 84.5%.

With electronic transmission, patients are usually reimbursed within a week. When transmission itself becomes much cheaper and faster than paper, the remaining business opportunity moves toward organising operations before and after transmission: provider registration, error correction, and status guidance.

Four small products that could be sold

1. A clinic connection application guide

• What: A service where a clinic enters its programme name and version, then receives support status, application steps, and questions to ask its provider.
• Who: Internal medicine and ear, nose, and throat clinics with one or two doctors and several administrative staff, using a supported programme but not yet completing connection.
• Why now: Expected connection coverage is 96.1%, while actual completion is 47.7%, leaving a large gap between software availability and real use.
• First screen: Show only an input field labelled “Check our clinic connection status” and three steps: support check, application, and test transmission.

2. An indemnity-claim enquiry triage board

• What: A service that sorts what patients say into three failure stages and gives staff checking questions and response wording.
• Who: Clinics with roughly three staff who receive hospital lookup, transmission, and insurance-payment enquiries at one desk after connecting to Silson24.
• Why now: Cumulative electronic claims have reached 4.61 million, but clinic-search failures and insurer review delays still need to be handled by different parties.
• First screen: Show three buttons: “The hospital does not appear,” “The treatment record does not appear,” and “Payment has not arrived after transmission.”

3. A patient-information generator

• What: A service that creates clinic-specific claim-route guidance, automatically transmitted documents, and documents that may need separate issuance for text messages and reception-desk notices.
• Who: A neighbourhood orthopaedic clinic newly connected to Silson24, where patients still ask about paper receipts and additional documents.
• Why now: As Naver and Toss have added claim entry points, staff now need to explain what patients choose on which screen.
• First screen: After selecting the medical specialty and communication channel, show a preview of a QR code patients can scan with a phone, a text message, and a printed notice.

4. A multi-branch failure log

• What: A service that records error times, software-provider responses, and retransmission results by branch, then groups recurring problems.
• Who: A clinic group operating five family medicine clinics, where one headquarters administrator consolidates technology enquiries.
• Why now: Claim entry points have multiplied, but a clinic programme’s connection status and an insurer’s review status are not visible on one screen.
• First screen: Show unresolved cases by branch and lists for “Waiting for provider response,” “Waiting for additional patient documents,” and “Insurer confirmation needed.”

Today, call three clinics

Find three nearby clinics shown as fully connected on Silson24. Ask each administrative manager only how many times each of the three enquiry types occurred in the past week and where they recorded them. If at least two of the three clinics say the same enquiry recurred three or more times and was handled through notes or staff memory, the indemnity-claim enquiry triage board is worth building first.

Why this matters where you are

Korea’s conditions are specific: Silson24 is a shared claims route, and Naver, Naver Pay, and Toss are already patient-facing entry points. In your market, check whether a common transmission rail exists, who controls patient entry points, and where clinics still rely on staff memory or notes after transmission. If transmission is already cheap or included elsewhere, test an operational tool before building another claims network.