Claims and policies, handled with care.
We automate the administrative work around claims, eligibility, authorisations and policies. Protected health information stays masked, logged and in scope.
Administrative load is crowding out care.
Payers and providers spend large teams on portal lookups, form keying and status chasing. A single claim can touch an intake mailbox, a practice management system, a payer portal and a claims platform before anyone makes a decision.
Insurers face a similar picture on the policy side. Proposals arrive as scanned forms, endorsements come by email and every change must be reflected in the policy administration system with an audit trail. Turnaround times are watched by regulators and customers alike.
Each payer has its own portal, login and screen layout for eligibility and authorisation.
Claim forms, clinical notes and attachments arrive as scans and faxes.
PHI and PII must be protected at every step, including bot logs and screenshots.
Where automation pays in healthcare.
Claims intake
Classify incoming claims and attachments, extract member, provider, diagnosis and procedure codes and create a clean claim record with confidence scores.
01Adjudication support
Pre-check claims against policy rules, flag duplicates and missing documents, and assemble the evidence an adjudicator needs on one screen.
02Eligibility and benefits verification
Query payer portals or eligibility transactions before appointments and write coverage, copay and deductible details back to the scheduling system.
03Prior authorisation
Compile clinical documentation, submit requests through payer portals, track status and alert staff to pending information requests before deadlines.
04Provider credentialing
Collect licences and certificates, verify them against primary sources, track expiry dates and keep the provider directory current.
05Policy issuance and endorsements
Key proposals into the policy administration system, apply endorsements from email requests and generate policy documents for review.
06Revenue cycle tasks
Post remittances, work denials by reason code, prepare appeal letters and chase outstanding receivables across payer portals.
07Member and patient servicing
Update addresses, issue ID cards, answer status queries and route complex cases to the right team with full context.
08Medical records requests
Log requests, check authorisation to release, retrieve records and redact fields before release under supervision.
09Considerations we design for.
- HIPAA minimum necessary principle applied to every bot role and data flow
- PHI masking in logs, screenshots, queue payloads and AI prompts
- IRDAI-style turnaround tracking for claims and policy servicing
- DPDP Act 2023 and GDPR obligations for health data where they apply
- AI models deployed in your tenancy with no training on your data
- Human review of every clinical or coverage decision, with bots in support roles only
- Access to payer portals through vaulted, individually attributable credentials
- Retention and purge rules for extracted data aligned to your policy
Less chasing, faster decisions.
Eligibility checks
Coverage is confirmed before the patient arrives.
Avoidable denials
Missing documents and coding gaps are caught at intake.
Authorisation deadlines
No request lapses because nobody checked the portal.
Sensitive data
PHI never appears in plain text outside the systems of record.
Do bots make clinical or claim decisions?
No. Bots gather, validate and present information. Coverage and clinical decisions stay with qualified staff, and the bot records who decided.
How do you handle PHI in AI document extraction?
We use models deployed in your cloud tenancy, mask identifiers in prompts where possible and keep no copies outside your environment.
Can you work with many different payer portals?
Yes. We build a reusable portal adapter pattern so each new payer is a configuration and a small set of selectors.
What happens when a payer changes its portal?
Health checks detect layout changes early. Managed support then patches the affected adapter, usually without touching the rest of the process.
Do you support both payers and providers?
Yes. We work on payer, provider and insurer processes, and the same controls apply across all three.
Find your first ten automations in two weeks.
A structured discovery sprint that maps your processes, scores them for automation potential and hands you a prioritised roadmap with effort and payback for each.