AI-powered adjudication engine
Faster claim decisions.Stronger fraud detection.Explainable medical review.
VerifAI turns complex medical claims into structured extraction, clinical reasoning, billing validation, fraud signals, queue status, and report-ready outcomes inside one reviewer-first workspace.
Live queue orchestrationDoctor opinion workflowInsurer-ready reporting
claim_analysis / CLM-2026-00482Processing
Structured Extraction
Live- DiagnosisAcute Appendicitis
- DoctorDr. R. Sharma
- Amount₹1,24,500
- MedicinesAugmentin, Pantop, Emeset
Fraud Review
AlertsHandwriting similarity detected across submitted pages
GST details missing from invoice structure
LOS exceeds guideline expectation by 2 days
5M+Documents Processed
150+Fraud Rules Active
40%Manual Review Reduction
24x7Queue Visibility
Platform
One operational layer for clinical review, fraud detection, and outcome delivery.
Built for insurers, TPAs, medical reviewers, and operations teams that need evidence, not black-box outputs.
Operational visibility from intake to completed case.
See who uploaded, who reviewed, what was queued, what failed, what needs doctor opinion, and what is ready for insurer-facing report generation.
Queue visibilityTrack OCR, QC, review, and completion states in one lane.
Doctor versioningSave revised opinions and generate reports from the latest approved draft.
Callback-ready deliveryPush results as structured outputs back into upstream claim systems.
Clinical Intelligence
Correlate diagnosis, investigations, treatment pathway, LOS, ICU need, and procedure necessity in one review layer.
Fraud Memory
Learn from historical rejections, handwriting matches, financial leakage patterns, and suspicious provider behavior.
Delivery Layer
Push structured outputs into queues, doctor workflows, insurer formats, and signed callback responses without manual rewriting.
Capabilities
Specialized building blocks that work together on every claim.
OCR + Extraction
Understands PDFs, scanned bills, discharge summaries, prescriptions, and merged document sets with field anchoring.
DiagnosisMedicinesDoctor Reg. No.
Medical Rule Engine
Combines clinical rules, investigation alignment, drug appropriateness, LOS logic, and admission necessity checks.
LOSInvestigationsOPD vs IPD
Fraud & Billing Signals
Flags duplicate receipts, missing GST, invoice weakness, handwriting similarity, and provider-level behavioral risks.
GSTDuplicate BillsHandwriting
Reviewer Workspace
Lets doctor teams edit opinion versions, save report drafts, complete cases, and generate insurer-ready report outputs.
Doctor OpinionVersioningQC
Workflow
Designed for real operations, not demo-only claim flows.
Claim Intake
Bring claims through Excel, S3, direct upload, or API metadata handoff.
Document Assembly
Merge claim documents, normalize access, and prepare evidence for extraction.
AI Extraction
Capture diagnosis, medicines, billing fields, doctor details, and structured evidence.
Clinical + Fraud Review
Run medical validation, fraud rules, risk scoring, and reviewer escalation logic.
Decision Delivery
Publish queue status, doctor opinion, report output, and callback-ready JSON.
Security & delivery
Built for secure claim exchange, reviewer control, and audited decisions.
The platform supports role-based workflows, structured report delivery, signed callbacks, and operational auditability for production healthcare review teams.
•Role-based reviewer access
•Signed webhook callbacks
•Structured audit history
•Encrypted cloud storage patterns
Ready to operationalize review?
Move from scattered documents to explainable claim decisions in one workspace.
Use VerifAI to centralize extraction, doctor opinion, fraud checks, and insurer-ready report delivery.