For health insurers and TPAs
Less paperwork.
More judgment.
Your team should be reviewing claims, not piecing them together. Judivo automates the checks and brings the decisions that matter to you.
AI-native checks. Human-led decisions. Your rules.
Reimbursement claim
CLM–40217
₹18,200
All clear. No queue required.
All checks passed and within the example approval rules. Ready for straight-through processing.
Reimbursement claim
CLM–40220
₹41,000
One missing piece. Not a mystery.
Missing Indoor Case Papers (ICP). Routed to the claims desk with the completed checks attached.
- One claim. Every angle.
- Five connected validation modules
- Exceptions, not busywork.
- Risk-based routing to the right team
- Your operation. Your pace.
- Start with one module, grow from there
A whole claim.
Not a collection of blind spots.
Five modules that work independently. Even better together. Pick the checks your team needs most.
Less rekeying. More reviewing.
From scattered documents to a structured claim.
Bring claims in from email, hospital portals, insurer systems, and e-forms. Judivo reads the paperwork so your team doesn’t have to enter it again.
- Read scanned bills, prescriptions, and discharge summaries
- Turn clinical text into structured claim fields
- Map diagnoses and procedures to standard codes
A structured claim, ready for validation.
The actual policy. Not an assumption.
Know what’s covered before the claim moves on.
Check the policy issued to this policyholder, including riders and endorsements. Keep eligibility decisions tied to the right version of the policy.
- Verify coverage and waiting periods
- Check exclusions, sub-limits, and co-pay terms
- Preserve the policy version behind each check
Coverage findings with the policy context attached.
Does the clinical story add up?
Connect the diagnosis, treatment, and specialist.
Check whether the clinical details agree with one another. Surface inconsistencies before the claim reaches your medical reviewer.
- Cross-check diagnoses, procedures, and medication
- Verify that the treating specialty fits the diagnosis
- Flag treatment and length-of-stay anomalies
Clinical exceptions ready for a medical review.
Find the gap before the handoff.
A complete file. A consistent account.
Check that the right documents are present and that their details agree. Give the claims desk a specific missing item, not another round of guesswork.
- Check required documents for each claim type
- Reconcile dates, bill totals, signatures, and stamps
- Surface duplication and signs of tampering
A clear list of missing or inconsistent evidence.
Every line item deserves a check.
Pay against the right rate, not just the billed rate.
Validate cashless claims against hospital contracts and reimbursement claims against regional customary rates. Bring unusual charges into focus.
- Match cashless bills to contracted rate cards
- Compare reimbursements with regional UCR rates
- Flag outlier charges and recurring provider patterns
Rate exceptions with the comparison behind them.
Fraud and anomaly detection is built into each module. Not bolted on at the end.
The right claim.
On the right desk.
Cashless or reimbursement, every claim arrives with context: what passed, what flagged, and what needs a person.
You define the green light.
Set straight-through processing rules by amount, hospital, policy history, and validation results. A small claim with a red flag still goes to a person.
- 1
Bring it together
Claims arrive from your existing channels. Documents become structured, reviewable information.
- 2
Check every angle
Coverage, clinical details, documents, and rates are checked. Findings stay attached to the claim.
- 3
Move it forward
Clean claims can skip the queue under your rules. Exceptions go to the team best placed to resolve them.
Less chasing updates.
More knowing where you stand.
Live and periodic reporting for the people running the operation. As claims move, the picture updates—with no extra status report to write.
Operations
See the queue before it becomes a backlog.
Adjudicator productivity, workload balance, and volume against capacity.
Finance
Know where the leakage is.
Chargeback exposure, recovered leakage, and cost-per-claim trends.
Compliance
Keep the reasoning, not just the result.
Turnaround-time tracking, early breach alerts, and a full history of checks.
Start with one bottleneck.
Not a system overhaul.
Begin with a diagnostic of how your claims move today. Add the module that helps most, then expand when you’re ready.
- Your portal, or ours
- Connect to the claims system you already use, or work in Judivo.
- Your claims data stays yours
- Never used to train models for other customers. On-premise and private cloud deployment options.
Find your starting point
What’s slowing your team down?
No signup. No claim data. Just a practical first step.
Your suggested first module
Data ingestion
A structured claim, ready for validation.
Policy validation
Coverage findings with the policy context attached.
Clinical validation
Clinical exceptions ready for a medical review.
Document validation
A clear list of missing or inconsistent evidence.
Finance & rates
Rate exceptions with the comparison behind them.
- Map the current workflow and where review time goes.
- Define a narrow pilot with your team’s review rules.
- Compare handling time and exceptions before expanding.
An initial guide, not a completed diagnostic. Nothing has been sent or saved.