Reimbursement Claims
Every reimbursement claim read, checked and priced, with a cited file ready for decision in a day.
Why it matters
Members send bills, prescriptions and reports in bundles; missing papers trigger query after query and claims sit past the regulatory clock, attracting interest.
How the solution handles it
Agents read every document, check that the set is complete, check cover and limits, price bills against tariff, look for duplicates across claims and draft the settlement note. Missing items go out as one request. A claims assessor approves and signs.
How a claim moves
Six agents read, check completeness, cover and bills, find duplicates and draft the note; a claims assessor approves and signs.
What it reads, and what it hands back.
What goes in
- Claim form and bank details
- Hospital bills and receipts
- Discharge summary and reports
- Prescriptions and pharmacy bills
- Policy schedule
What comes out
- Settlement note ready to sign
- Single document request
- Payable amount by line
- Clock on every claim
Who uses it
The difference, in numbers.
Every figure is labelled: a target the solution is built to, an estimate, a typical published result, or a proven one.
Context: IRDAI policyholder-protection rules set settlement timelines and interest at bank rate + 2% on delay · “Target” = design goal, measured in the live solution · agents = the live solution’s configuration
6 specialist agents. One person decides.
More in this division.
Every cashless request checked against policy and tariff, ready for a doctor well inside the 1-hour clock.
Discharge SettlementEvery final bill checked against the pre-auth and tariff, so final authorisation lands well inside 3 hours.
Bill & Tariff AuditEvery hospital bill audited line by line against agreed tariffs and packages, every deduction cited.
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