Every Claim Takes Too Long to Settle
A claim that should settle in minutes sits in queues for days — eligibility, code validation, and policy checks all done manually.
Trusted by startups and global leaders
What Is Actually Breaking Your Claims Operation
These problems are accepted as normal. They should not be. Each one compounds daily — in overhead, fraud losses, provider frustration, and eroded trust.
Fraud Is Outpacing Your Detection Tools
Beyond duplicate claims and upcoding, billing rings, AI-generated documents, and synthetic identities slip past rule-based systems.
Denial Rates Are Too High for the Wrong Reasons
Preventable denials — wrong codes, missing documents, eligibility errors — drive rework, appeals, and provider frustration.
Your Team Is Doing Work a Machine Should Do
Skilled analysts key data, cross-check policies, and route simple claims that need no human judgment — an expensive use of experts.
No Real-Time View of Fraud Risk
By the time fraud surfaces in a post-payment audit, the money is gone — recovered only in fractions, cycle after cycle.
How the Platform Works — Stage by Stage
From intake to settlement, AI reduces manual work, improves accuracy, catches fraud, and surfaces the information your team needs at every stage.
What You See in the Claims Dashboard
Real-time visibility across the full claims operation — not a report you request, but a live view your entire team can act on the moment something needs attention.
Live Claims Pipeline
Every claim, at every stage, in real time — volume by status, claim type, provider, and region. Straight-through processing rate and average settlement time tracked live, no status update required.
Fraud Risk Heatmap
A visual view of fraud risk across your claims portfolio — by provider, geography, procedure type, and claim source. See where suspicious activity concentrates and which providers are rising in risk, with alerts that surface before payment.
Financial Leakage Report
Estimated savings from fraud prevention and automated coding checks, plus recovery from post-payment audits. Denial rate by reason, first-pass approval rate, and prior auth turnaround — all trended so leadership sees the cumulative financial impact.
What Teams Are Experiencing After Going Live
Each result traces to a specific operational problem we fixed.
Book a Live Demo85%
Claims settled within 24 hours — up from 40%. Settlement time dropped from 22 days to under 6. Provider satisfaction up 30 points in one quarter. — Regional Health Insurer, Hyderabad
₹4 Cr
Fraud losses prevented in 6 months. Pre-payment scoring caught suspicious claims before a single rupee went out. — Chief Risk Officer, TPA, Delhi
4%
Denial rate after 3 months — down from 14%. Coding validation caught preventable rejections before submission. — Revenue Cycle Head, 450-bed Hospital, Kochi
75%
Reduction in resolution time. From 30-day cycles to under 8 days — straight-through processing handles routine claims without human review.
Zero
Prior auth backlog after automation. Routine decisions in minutes. Clinical escalations assembled with full context — no digging required.
10×
Increase in analyst productivity. Staff moved from routine data entry to complex cases that actually need human judgment.
Who This Platform Serves
Built for the full ecosystem of health insurance operations — from large insurers and TPAs to government schemes, hospital billing teams, and self-insured employers. Hover or tap to see what it fixes for each.
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Health Insurance Companies
Health Insurance Companies
Processing thousands of claims daily while carrying the cost of manual review and fraud slipping through. AI adjudication and fraud detection directly improve your loss ratio and operational cost.
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Third Party Administrators
Third Party Administrators
Your business runs on processing efficiency. Speed, accuracy, and fraud prevention determine whether clients stay. Our platform delivers all three at the volume and SLA they expect.
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Government Health Schemes
Government Health Schemes
Government schemes face volume and fraud challenges in their most extreme forms. Our platform is built for NHCX standards, ABHA integration, and ICD-10 coding — handling both at scale.
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Hospital Billing & Revenue Cycle Teams
Hospital Billing & Revenue Cycle Teams
The goal: maximum clean claim rates, minimum denials. Our platform catches coding errors before submission, tracks denial patterns, and automates appeals for wrongly rejected claims.
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Corporate Self-Insured Employers
Corporate Self-Insured Employers
Self-insured employers need insurer-grade fraud protection and processing efficiency — without the IT budget. Our platform scales to your employee population.
Built to the Standards That Health Insurance Actually Runs On
Every standard is scoped during implementation and built into the platform, covering privacy, transaction, coding, and security frameworks for claims processing.
Data Privacy
Healthcare Data Privacy
Data privacy and security across every data store and access control.
Indian Health Insurance
NHCX & Ayushman Bharat
NHCX standards and government scheme integrations for India.
Coding Standards
Clinical Coding & Classification
Coding standards validated at intake, review, and pre-adjudication.
Transaction Layer
EDI Transaction Standards
How eligibility, claims, remittance, and authorization data move.
Security
Security & Audit
Security certifications and audit trails for PHI and claims data.
Cashless & Reimbursement
Both Claim Types Supported
Cashless and reimbursement workflows, SLAs, and document needs.
Claims Should Take Minutes, Not Weeks. Fraud Should Be Caught Before Payment, Not After.
Manual review, rule-based fraud tools, and 20-day settlement cycles cost you every day — in overhead, fraud losses, and provider frustration. Our Claims Processing AI is the upgrade that pays for itself.
Book a Claims Demo
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Highly Rated on Trustpilot
Verified Agency
Top App Development Company
ASSOCHAM Member
Frequently Asked Questions
[ 1 ]
How does the AI know what is fraudulent versus what is just unusual?
The model scores claims on a combination of specific risk signals — historical fraud cases, billing patterns, coding standards, and provider benchmarks — not just whether a claim looks unusual. Every flagged claim includes a transparent explanation of what triggered the alert, so your team decides with context, not guesswork.
[ 2 ]
What coding standards and systems does the platform support?
Supports ICD-10, CPT, SNOMED, and LOINC, aligned with NHCX standards. Integrates with ABHA and Ayushman Bharat claim flows for both cashless and reimbursement types.
[ 3 ]
Can hospitals use this on the provider side for claim submission?
Yes. The provider module validates claims before submission — coding accuracy, completeness, policy eligibility — so hospitals fix issues before the claim reaches the insurer, reducing denials and rework.
[ 4 ]
How long does implementation take?
Most insurers and TPAs go live within 6–10 weeks. Our team handles integration with your claims system and policy database. Fraud models are calibrated on your historical data so they are tuned to your portfolio from day one.
[ 5 ]
What happens to the claims that the AI cannot adjudicate automatically?
They route to your team with a full case summary — claim details, policy clauses, AI recommendation, and why automation was not appropriate. Your team decides with full context. The AI never forces a decision where human judgment is needed.
[ 6 ]
Is the system auditable for regulatory compliance?
Yes. Every decision — automated or human-assisted — is fully logged with the data, rules applied, and outcome. IRDAI requirements for claims documentation and grievance redressal are supported, with the audit trail available at any time.
Global presence
