Overview

ALFRED by Artivatic.ai is a comprehensive AI/ML-driven health insurance claims platform. It automates the full claims lifecycle — from document ingestion and pre-authorization to auto-adjudication, fraud detection, and final settlement. ALFRED supports cashless claims, post-discharge reimbursements, and integrates insurers, hospitals, TPAs, and providers via APIs for a unified, digital, and transparent claims ecosystem.

Features and Capabilities

• Document Digitization & Processing: OCR/ICR for printed, scanned or handwritten medical bills and discharge summaries.
• Automated Claims Adjudication: Supports cashless (pre-auth), reimbursement, OPD, hospi-cash and full discharge claims.
• Medical Coding & Billing Automation: Automatic ICD/IRDA/PCS coding, tariff and contract validation, and billing compliance checks.
• Fraud, Risk & Abuse Detection: AI-based fraud intelligence, anomaly detection, historical data assessment and provider profiling to identify overbilling, upcoding, and duplications.
• Provider & Network Management: Integrates hospitals, labs, clinics, TPAs and pharmacies, including provider empanelment, contract management and tariff administration.
• No-Code Rule & Product Configuration: Allows insurers to configure benefit rules, inclusions, exclusions and tariff schedules dynamically without coding.
• Workflow, QC & Audit: Offers role-based access, QC workflows, audit logs and multi-stakeholder coordination across TPAs, providers, insurers, billing teams and QC units.
• Rapid Deployment & Scalability: Cloud-based delivery enables fast implementation, high scalability and fully managed SaaS operations.
• Improved Efficiency & Cost-Reduction: Reduces claims turnaround time, minimizes manual errors, improves accuracy and lowers operational processing costs.