The reliable spine
The non-AI spine is the source-linked workflow: clean records, rules, calculations, integrations, exception queues, approvals and reporting for The claims engine across TPA, insurance and schemes.
Healthcare Providers (Hospitals, Diagnostics)
The claims engine across TPA, insurance and schemes
This is healthcare's hardest money problem and where the three-businesses-in-one reality bites hardest: pre-authorisations get stuck, claims come back with deductions or are denied for a missing document or a package-rule breach, and the billing desk, overloaded, accepts the short-pay because nobody is analysing why. Cash patients, TPA and insurance patients, and government-scheme patients (PM-JAY / Ayushman, CGHS, ECHS, state schemes) each carry a different rate card, document set and timeline, and treating them as one process is how money is lost.
Who has it
Core for multi-specialty and secondary hospitals and for nursing homes and day-care or surgical centres, where it is the operating heart of hospital money; lighter for diagnostic and pathology lab chains and for polyclinics and OPD clinics.
What we build
One tracked claims pipeline across every payer that, for each claim, checks the documents are complete before it goes, checks the billed amount against the payer's rate card and package rules, tracks the pre-authorisation, and analyses every denial by reason so the same avoidable rejection stops repeating. It runs to the payer's calendar with named owners and escalations, the disciplined, defensible, audit-trailed form regulated payer work demands. Regulation is navigated as part of the work, and the cleaner claim discipline becomes a selling point with payers, not a burden.
What is automated, where AI helps, who signs off
Automation for the routine. A person on every decision that matters.
Where AI helps
AI is limited to bounded reading, extraction, matching, clustering or drafting from the firm's own data for The claims engine across TPA, insurance and schemes; it never owns the number, the approval, the promise or the decision.
Who signs off
A named person signs off anything touching money, stock, a customer promise, a regulated filing, a payment, a price, a credit decision or a people decision.
What changes day to day
Avoidable denials stop repeating; clean claims go out complete and correctly priced; deductions get disputed instead of accepted; the same rejection reason is fixed at source.
Illustrative outcome
A meaningful share of previously written-off or short-paid claim value recovered, and fewer first-pass denials. Illustrative; final numbers come from your own data.
Illustrative; final numbers come from your own data.
Path to the build
How this one gets built.
Book a free 60-minute call, then a free Blueprint on the firm's own records. Deep-dive and build, followed by run and govern so the workflow keeps paying back.
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