Intelligent Claims Automation
ICA – From Excel Reconciliation to Exception-Driven Revenue Intelligence
01.
Problem
- Hospitals reconcile HIMS / insurer / bank data in Excel – 2-3 hours per cycle
- 20–30% of valid claims go unmatched on exact-match logic – missed revenue
- Each new insurer requires custom import code – weeks of IT work
- Audit-time discovery of stuck claims – cash flow & compliance pain
02.
Solution
- AI-driven 3-way reconciliation: HIMS ↔ Insurer Portal ↔ Bank in one engine
- Configurable insurer templates – onboard a new payer in hours, not weeks
- Exception-driven dashboard – your team handles only genuine mismatches
- Cloud (Azure) or on-premise; integrates with existing HIMS via secure APIs
03.
Key Capabilities
- AI data normalization: standardizes column names, amounts, dates, patient names
- Multi-field fuzzy matching (≥85%) – auto-links claims across format variants
- Intelligent dedup at file checksum + record level – data integrity guaranteed
- Real-time dashboard: match rates, pending amounts, insurer-wise trends, aging analysis
04.
Business Impact
- Zero manual data cleaning – hours saved per reconciliation cycle
- 80% reduction in exception-review time via prioritized dashboard
- Same team handles 3x insurer volume – operational leverage, no new headcount
- Faster cash flow, fewer write-offs, audit-ready trail for every claim
05.
Example Use Cases
- Multi-specialty hospital: 4 insurers, 600 claims/week – cycle time 8h → 45 min
- TPA: onboard new payer via template – production-ready same week
- Finance team: live dashboard of pending revenue replaces weekly Excel reports
- Audit: instant trail – every upload, match, status change, user action logged
06.
Why MediAstra
- Honest AI: real ML models where they add value; reliable algorithms where they're better
- Healthcare-domain DNA – built for Indian hospital realities, not generic finance ERPs
- Modular – start with one insurer, scale to full payer portfolio
- Engineered in India. Delivered to the world.