https://store-images.s-microsoft.com/image/apps.49439.34757bee-20f3-41d2-bc59-e05abbb69388.79f5fea6-e179-4ccf-acf4-8d8cfa9533a8.c38715b8-9d2f-4b0b-a7df-409df598b223

ALFRED - AI Health Claims Automation

بواسطة Artivatic.ai

ميزة Azure مؤهلة

Make health claims easy, both for cashless (pre-auth claims) & post discharge (reimbursement claims)

ALFRED is an advanced platform designed for seamless health claims processing, offering instant claim resolution, hassle-free filing via mobile or web, and AI driven instant decision-making capability. This fully automated, touchless, end-to-end solution efficiently manages both cashless claims (planned and emergency) and post-discharge reimbursements, enabling insurers and Third Party Administrators (TPAs) to optimize their operations.

Smarter, Customer-Centric Claims Processing Solution

Leveraging OCR, ICR, and AI, Alfred automates claims processing by analyzing medical bills, advanced medical reports, lab test reports, hospital papers, invoices, and claim forms for accurate assessment and settlement. Customers / Hospitals / TPAs can file claims seamlessly via mobile or web, uploading required documents for instant processing. Alfred applies AI-driven ICD medical coding, auto-adjudication, fraud (FWA) detection, and medical relevancy checks. It ensures policy validation, treatment compliance (STG), and fraud prevention, leading to faster settlements, reduced costs, and improved transparency. Alfred transforms claims management into a seamless, intelligent, and hassle-free process.

Key Challenges in the Health Insurance Ecosystem

  • Lack of End-to-End Transparency: Limited visibility throughout the claim's lifecycle—from claim filing to decision/payout — leading to customer / provider dissatisfaction
  • Slow and Complex Claims Processing: Traditional manual workflows delay approvals and settlements, frustrating stakeholders.
  • Challenges in Fraud Detection: Manual methods struggle to detect fraudulent claims or accurately assess risks, exposing insurers to financial losses.
  • Poor Customer Experience: Complicated filing processes and a lack of real-time updates leave policyholders dissatisfied during critical times.

Key Benefits and Proof Points

  • 100% cases go through 20+ different Fraud, Waste, and Abuse (FWA) checks to ensure comprehensive identification and prevention.
  • 12% to 18% Cost Savings: Achieved by replacing manual processes with automated, touchless operations.
  • 50% to 70% Time Saved: Significant reduction in turnaround time (TAT) for claims processing.
  • 85% Increase in Automation and Digitization: Transforming manual workflows into seamless, AI-driven processes.
  • OCR/ICR Accuracy: 99% accuracy for printed text and 90% for handwritten documents.
  • Digitized claims and medical data powers smarter insights—enhancing early claim prediction, suggesting proactive care, enhancing intelligence for underwriting / adjudication and many more.

How to Start

Click on 'Get It Now' button to start with your pay as you go or enterprise plan or contact us here for a live demo here.

لمحة سريعة

https://store-images.s-microsoft.com/image/apps.52569.34757bee-20f3-41d2-bc59-e05abbb69388.79f5fea6-e179-4ccf-acf4-8d8cfa9533a8.3df54549-8ce4-4923-a693-dfde17665984
https://store-images.s-microsoft.com/image/apps.60765.34757bee-20f3-41d2-bc59-e05abbb69388.79f5fea6-e179-4ccf-acf4-8d8cfa9533a8.dd0b132d-3230-453c-b7a1-f739b6cfeed2
https://store-images.s-microsoft.com/image/apps.54194.34757bee-20f3-41d2-bc59-e05abbb69388.79f5fea6-e179-4ccf-acf4-8d8cfa9533a8.ef42bd46-2502-42a4-a903-aca67259952f