AI-Powered Adjudication Engine
Medical Fraud DetectionAccelerated by Intelligence.
VerifAI transforms complex medical claims into structured risk signals, clinical reasoning, fraud indicators, and delivery-ready decision outputs with a cleaner, reviewer-first workflow.
OCR Extraction
- DiagnosisAcute Appendicitis
- DoctorDr. R. Sharma
- MedicinesAugmentin, Pantop
- LOS4 Days
- Amount₹1,24,500
Fraud Alerts
Handwriting similarity detected across documents
GST number not found in extracted invoice text
LOS exceeds guideline expectation by 2 days
Core Platform
One platform for claim adjudication, medical review, and fraud intelligence.
Built for healthcare insurers and review teams that need explainable automation, not black-box outputs.
Deep Clinical Intelligence
The engine maps symptoms, investigations, medicines, and timeline evidence to clinical necessity so reviewers can trust every recommendation.
98%Clinical field capture
150+Fraud and billing checks
RealtimeQueue-to-decision flow
High-Fidelity OCR
Extract fields from discharge summaries, bills, hand-written notes, and merged PDFs with clinical context preserved.
Policy Intelligence
Check exclusions, limits, PED logic, waiting periods, and insurer-specific adjudication rules in one pass.
Fraud Memory
Learn from prior rejected claims, suspicious providers, drug anomalies, and historical review outcomes.
Modules
Specialized AI blocks working together across the full claim journey.
Clinical Intelligence
Cross-check diagnosis, investigations, medicines, LOS, ICU use, and procedure necessity.
DiagnosisLOSMedicines
Fraud Analytics
Detect duplicate bills, handwriting similarity, invoice tampering, provider anomalies, and financial inconsistencies.
TamperingGSTPatterns
Operational Delivery
Push structured claim outcomes through queues, reviewer workflows, JSON callbacks, and insurer-specific reports.
QueuesCallbacksReports
Workflow
From intake to outcome delivery in a single operational lane.
1Claim Intake
2Document Access
3OCR + Extraction
4Clinical Validation
5Fraud Review
6Decision Delivery
Industries
Built for every stakeholder in the claim review ecosystem.
Insurance Companies
Operational visibility, structured evidence, and faster reviewer handoff.
TPAs
Operational visibility, structured evidence, and faster reviewer handoff.
Hospitals
Operational visibility, structured evidence, and faster reviewer handoff.
Investigation Agencies
Operational visibility, structured evidence, and faster reviewer handoff.
Corporate Healthcare
Operational visibility, structured evidence, and faster reviewer handoff.
Legal Review Teams
Operational visibility, structured evidence, and faster reviewer handoff.
5M+Documents Processed
98%OCR Accuracy
150+Fraud Rules Active
40%Manual Review Reduction
Transform Insurance Claim Investigation With AI
Move from fragmented medical documents to confident, explainable decisions.
Reduce fraud, accelerate adjudication, and strengthen clinical review with one connected intelligence workspace.