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, 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, 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: Integration of hospitals, labs, clinics, TPAs and pharmacies, including provider empanelment, contract management and tariff administration.
• No-Code Rule & Product Configuration: Enables insurers to configure benefit rules, inclusions, exclusions and tariff schedules dynamically.
• Workflow, QC & Audit: Provides role-based user management, QC workflows, audit logs and coordinated work between TPAs, providers, insurers, billing teams and quality-control units.
• Rapid Deployment & Scalability: Cloud-based delivery supports fast go-live, scalability and managed SaaS operations.
• Improved Efficiency & Cost-Reduction: Reduces claims turnaround time, improves accuracy, decreases manual work and lowers operating costs.