Automate health claims—end‑to‑end.

Digital Wellness

Our wellbeing programs are designed to support members in leading healthier, more fulfilling lives. Regular risk assessments help identify potential health concerns early, enabling timely intervention and prevention. By analyzing lifestyle factors and health data, we deliver personalized insights that empower members to make better choices. Simple, timely nudges—like reminders for check-ups, medication adherence, or activity goals—encourage consistent healthy behaviors. These initiatives not only improve overall wellness but also reduce long-term healthcare risks. With a proactive approach, members feel more engaged and supported in their health journey, leading to better outcomes and improved quality of life.

Health Claim Scrubber

The Health Claim Scrubber ensures claims are accurate, compliant, and ready for smooth processing before submission. By automatically identifying coding errors, missing information, and policy mismatches, it helps reduce denials and payment delays. Advanced rules and AI-driven validation checks enable payers and providers to resolve issues proactively, saving time and administrative effort. The system provides detailed error reports and recommendations, empowering teams to make quick corrections. With cleaner claims, organizations experience faster reimbursements, fewer reworks, and improved financial performance. Ultimately, it strengthens compliance while enhancing efficiency across the claims lifecycle.

Pre‑Approval Clinical Evaluation

The Pre-Approval Clinical Evaluation streamlines the review of medical requests before treatment begins, ensuring that care aligns with clinical guidelines and payer policies. By validating medical necessity and appropriateness up front, it minimizes unnecessary procedures and controls healthcare costs. The system leverages clinical rules, evidence-based pathways, and AI-driven checks to support faster and more consistent decision-making. Providers benefit from reduced back-and-forth, while patients gain confidence in receiving timely and approved care. Automated workflows and documentation improve efficiency, freeing clinical teams to focus on patient outcomes. This proactive approach helps reduce denials and enhances trust between payers, providers, and members.

Claim Document Verification

Claim Document Verification ensures the accuracy and completeness of documents submitted with medical claims. Using advanced OCR and AI-driven validation, it automatically extracts key details and identifies mismatches or missing information. This process reduces manual review time and helps prevent costly rejections or delays in claim settlement. Expiry flags, document type checks, and audit trails add additional layers of security and compliance. Reviewers can track changes, verify authenticity, and streamline approvals with greater confidence. By standardizing document workflows, the solution improves claim accuracy, speeds up processing, and enhances trust between providers, payers, and patients.

Electronic Claim Submission

Electronic Claim Submission simplifies and accelerates the process of sending claims to payers and TPAs through secure EDI channels. The system ensures compliance with regional formats such as Bahrain/GCC while automatically validating claim data for accuracy. Real-time submission tracking keeps providers informed of claim statuses, reducing uncertainty and administrative follow-ups. ERA/remittance matching eliminates manual reconciliation by linking payments directly to submitted claims. By reducing paperwork and errors, providers save time and focus more on patient care. This seamless digital process not only speeds up reimbursements but also improves transparency and trust between providers and payers.

Medical Coding Solution

The Medical Coding Solution streamlines the process of assigning accurate codes to medical procedures and diagnoses with AI-powered assistance. It helps coders quickly search ACHI/ICD-10 references, reducing time spent on manual lookups. Built-in edits and bundling logic prevent errors and ensure claims meet payer requirements. The system also maintains a detailed change history, enabling audits and quality assurance with ease. By improving coding consistency and accuracy, providers can reduce claim denials and rework. This solution not only accelerates workflows but also enhances compliance with evolving coding standards, ensuring reliable reimbursement outcomes.