01UPLOAD
Bill uploaded
Drop a hospital PDF or phone photo up to 3 MB, then choose the insurer, TPA, daily room cap, and co-pay percentage.
AI Hospital Bill Auditor for Indian Health Claims
Read every hospital bill. Catch every deduction.
HealthClaims AI reads hospital bills for Indian TPAs, health insurers, and hospital billing desks. Upload a PDF or a phone photo and get every line item, the IRDAI non-payable scrub, room-rent cuts, co-pay, and the final payable amount in seconds.
IRDAI non-payable list appliedRoom-rent proportionate cuts calculatedA rule cited on every deducted line
Also from Evenor Info: Voice CRMTURNAROUND
Seconds per bill, not minutes
RULES
IRDAI lists & agreed rates
INPUT
PDF or phone photo
OUTPUT
Payable INR & CSV sheet
Interactive Claim InspectorSelect sample bill
CLM-MA-2026-8841Star Health via Medi Assist
ICD-10 M17.08 lines readManipal Hospital, Bengaluru
Bill line
Surgeon fees₹65,000 -> ₹52,000
Evenor Auditor: Room above policy limit
IRDAI Proportionate Deduction Clause: 20% reduction due to higher room category occupancy (INR 8,000 vs INR 10,000)
Patient & diagnosis
Suresh Kumar Nair, Knee replacement
Billed
₹2,48,500
Deducted or held
-₹60,850
Net payable
₹1,87,650Deductions flagged
Largest cut: Room above policy limit, ₹30,600
Awaiting auditor approvalEvery bill is saved with its line items, rule citations, and payable amount in INR.
TPA & Insurer Policy Presets
Pick the TPA, insurer, room cap, and co-pay before each bill is read.
TPAMedi Assist
TPAVidal Health
TPAParamount
INSStar Health
INSCare Health
INSNiva Bupa
Exported as CSV settlement sheet01 / Bill-to-Settlement Workflow
From hospital bill to payable amount.
Auditors still retype bills line by line and check each item against the policy by hand. HealthClaims AI reads the bill, applies the rules, and shows exactly why each rupee was cut.
02EXTRACT
Line items read
Vision models read the patient, hospital ROHINI ID, ICD-10 diagnosis, stay dates, and every billed row with codes and quantities.
03SCRUB
Rules applied
Flags items on the IRDAI non-payable lists and checks lab tests and packages against the hospital's agreed network rates.
04COMPUTE
Payable calculated
Applies room-rent proportionate cuts to linked fees, keeps implants and medicines exempt, then deducts the policy co-pay.
05SETTLE
Audit approved
Shows the bill beside the deduction breakdown and missing-document alerts, ready for approval and one-click CSV export.
02 / Audit Workspace
Built for claim auditors. Grounded in policy rules.
No more reading a 12-page bill beside a policy schedule. Every bill becomes a structured audit with each deduction explained, so reviewers approve faster and hospitals see fewer surprise short-settlements.
Settlement waterfallKnee replacement
- Hospital bill₹2,48,500
- Room above policy limit-₹30,600
- Co-pay (10%)-₹20,850
- Not payable (IRDAI list)-₹9,400
- Net payable₹1,87,650
CLAIM-01
Side-by-Side Bill & Audit
Review the original bill next to the extracted line items, so every number can be checked against its source at a glance.
CLAIM-02
IRDAI Non-Payable Scrub
Disallows gloves, kits, diet, registration, and other items on the IRDAI Annexure-I lists, with the list and item cited.
CLAIM-03
Room-Rent Proportionate Engine
When a patient stays above the policy room cap, linked fees are cut in the same ratio while implants and medicines stay exempt.
CLAIM-04
Missing Document Alerts
Holds items such as implants without a pouch sticker or invoice and tells the billing desk exactly what to attach before submission.
CLAIM-05
Multi-Model Vision Reading
Runs on Gemini 2.5 Flash by default, with open-weight Qwen and Llama vision models for teams that need self-hosting.
CLAIM-06
Exact INR Math & CSV Export
Billed, deductions, co-pay, and net payable are calculated by fixed rules, not guessed by the model, and export as a settlement sheet.
03 / Who It Serves
Five teams. One consistent claim audit.
Whether a TPA is settling a cashless final bill, an insurer is checking policy terms, or a hospital desk is scrubbing a bill before submission, every reviewer sees the same rules applied the same way.
AUDIT
Third-Party Administrators
High-volume cashless pre-discharge and final bill audits with consistent rules across every reviewer.
CASHLESS / TAT / SLA
AUDIT
Health Insurers
Policy checks for waiting periods, senior co-pay, room caps, and implant price ceilings on every claim.
POLICY / CO-PAY / CAPS
AUDIT
Hospital Billing Desks
Pre-submission scrubbing that catches unbundled package items and missing implant stickers before a TPA query delays discharge.
PRE-CHECK / PACKAGE / DESK
AUDIT
Multi-Specialty Hospital Chains
One audit standard across branches to reduce short-settlements, disallowances, and discharge waiting time.
RCM / BRANCHES / DISCHARGE
AUDIT
Corporate & Group Health Brokers
Reimbursement pre-audits so HR and broker desks can tell employees the payable amount and missing documents upfront.
GROUP / REIMBURSE / AUDIT
Ready for your claim desk
See HealthClaims AI audit one of your hospital bills.
Bring a sample bill and policy and we will walk you through extraction, IRDAI and network-rate checks, room-rent math, and the settlement export, using your own rules.