ZapSightEvery claim traceable. From diagnosis to payable.
CLaiM Engine transforms fragmented insurance claims into transparent adjudication — rendering every decision traceable from medical reality to policy intent. Not faster guesswork. Structural coherence.
The Number
faster claims processing — with 100% decision traceability. Every deductible, co-pay, and exclusion traced to its policy origin. Every audit trail complete before anyone asks for it.
The Problem
The Invisible Leakage
The modern claim is fragmented across hospitals, insurers, and customers — each in a different format. Manual interpretation creates variance; tariff mismatches create silent leakage.
- Linear workflow. Receive → sort → review → cross-reference → calculate. Every handoff adds latency.
- Manual reasoning. Every step adds error risk and inconsistency.
- No audit trail. When audit hits, reasoning is reconstructed from memory and scattered docs.
The Shift
Without CLaiM Engine. With CLaiM Engine.
How It Works
The system architecture, told simply.
Multi-Source Synthesis
NLP and ML engines ingest hospital discharge summaries, insurance policy details, tariff tables, and Ailment-specific conditions simultaneously — creating a unified claim topology.
Doctor-First Structuring
The AI engine assists doctors and billers in the claim adjudication journey, reducing TAT & increasing accuracy.
Transparent Adjudication
Insurance payable and claimant payable calculated as explicit, defensible figures. Every deductible, co-pay, and exclusion traced to its policy origin.
Continuous Integrity
Outstanding balances across claim categories reviewed continuously. Over-extension and under-reserving prevented in real time.
What You Get
Outcomes, not features.
Chain of Custody
Every claim component mapped to its source. From ICD codes to line-item exclusions, nothing emerges from a black box.
Visible Reasoning
Stakeholders witness not just what was decided, but why. Insurance payable, claimant payable, deductibles — all transparent.
Adjudicator Leverage
Routine claims process autonomously with full traceability. Complex cases arrive pre-synthesised with reasoning laid out.
Leakage Prevention
Automated tariff matching and continuous balance monitoring eliminate the invisible leakage that manual processing creates.
Resources
Everything you need to evaluate and share.
In Production
Quiet proof.
Claims adjudication system deployed across multi-source document processing.