Overview

Artivatic’s Early Claims offering is an AI-native claims automation module designed to detect, assess and accelerate the lifecycle of early-stage insurance claims, including health, motor and accidental claims. It leverages document digitization, medical and invoice analysis, auto-adjudication rules, and fraud and risk signals to speed decisions, reduce manual handling, and improve transparency between payers, providers and patients. The product forms part of Artivatic’s modular SaaS stack for insurers, TPAs and healthcare providers and integrates via APIs into core systems.

Features and Capabilities

• Document ingestion & digitization: Automated OCR/ICR and intelligent extraction of bills, discharge summaries, invoices and forms for structured processing.
• Medical evidence analysis & coding: Automatic ICD coding, treatment relevance checks and clinical-rule validations to verify claims legitimacy.
• Auto-adjudication & workflow orchestration: Rules engine and ML models for instant decisions or routing to investigation, supporting pre-authorization, discharge and settlement workflows.
• Fraud, waste & abuse (FWA) detection: Multi-model fraud analytics to identify anomalies, duplicate claims and suspicious patterns early in the lifecycle.
• Early-risk scoring & prioritization: Predictive models that score claim severity and escalation risk to enable fast-tracking or deeper review.
• Provider & patient portals / APIs: Interfaces for hospitals, TPAs and members to submit documents, track claim status and receive rapid decisions.
• Payment & settlement integration: Connectors for payout processing, reconciliation and finance workflows to accelerate settlement once approved.
• Dashboards & MIS: Real-time dashboards and management reports tracking turnaround times, auto-adjudication rates and operational savings.
• Configurable rule engine: Low-code/no-code configuration of policy rules, tariffs and regulatory requirements.
• Deployment flexibility: Delivered as modular SaaS/APIs with options to integrate into existing systems or run as a stand-alone claims solution.