End-to-End Claims Analysis Automation

Accelerating health claims processing with AI-powered analytics

How Acclaim Works?

Data Extraction

Extracts health claims data from the collected claims documents from the insurer's claims management system using advanced OCR and human-in-loop.

Encoding

Utilises industry-standard encodings (ATC, ICD, LOINC, SNOMED) for consistent data encoding.

Categorization

ML algorithm categorizes encoded data into treatments, procedures and investigations.

Anomaly Detection

ML-powered anomaly detection roots out non-included, anomalous and excessive charges

Insight Generation

Outputs generated insights directly into the insurer system in multiple format options.

Insurer Benefits from Acclaim Solution

Rapid Claims Processing

Claims decisions in as little as a few minutes, slashing processing times from hours to minutes.

Automated Payout Evaluation

Claims eligibility quantification without manual intervention.

Seamless Data Extraction

Format-agnostic document digitization including CSV, PDF, text, or scanned images.

Quality Control       

Airtight quality control on handwritten documents with human and OCR-assisted data extraction.

Predictive Analysis

Predictive modelling for policy pricing, tariff trend tracking and doctor/provider level analytics.

Bill Data Standardisation

Bill data codification using industry-standard medical classification systems like ICD, PCS, ATC and SNOMED.

Accurate Anomaly Detection

95% accurate anomalous and excess charge detection.

Seamless API Integration

Painless API-based integration with in-house systems, reducing setup time and costs.

Industry-Defining Challenges We Resolve

• 15% of health claims are fraudulent, or inflated with unnecessary or excessive investigations, treatments, and procedures.
• Manual claims data capture is not exhaustive and current technology like OCR is not 100% accurate.
• Insurers face an increasing dearth of data regarding patterns in healthcare provider treatment and claims veracity.
• Variations in claims terminologies across healthcare providers and geographies slow down claims processing.