Document intelligence
Classifies claim documents, extracts clinical and financial data, and highlights missing evidence.
AI-powered claims intelligence for insurers and TPAs
Smarter, Faster and More Controlled Claims Processing
KareAccess Health Claims AI turns fragmented claim files into a structured, review-ready decision—connecting clinical evidence, policy terms, tariffs, billing and risk in one governed workflow.
CLAIM REVIEWREADY
Claim packageClinical + Policy + Financial
DocumentsComplete
ICD mappingVerified
Exceptions2 routed
Decision trailRecorded
Recommended outcomeReview-ready with explainable deductions
One connected view of
Medical evidencePolicy coverageHospital tariffsBilling integrityFraud signals
A claims operating layer
From document pile to defensible decision
Automate repetitive analysis while keeping medical, policy and financial reviewers in control of every material outcome.
Policy-led validation
Applies policy conditions, riders, co-pay, deductibles, limits, exclusions and non-payable rules.
Clinical and coding review
Connects diagnosis, treatment and ICD coding while surfacing inconsistencies for medical review.
Financial adjudication
Checks tariffs, packages, duplicate billing and excess charges to recommend a defensible payable amount.
Fraud and risk signals
Prioritises suspicious patterns and material exceptions without replacing investigator judgement.
Controlled decisions
Routes exceptions to the right reviewer and records every action in an auditable workflow.
Connected workflow
Every check leads to the next right action.
Instead of disconnected screens and manual hand-offs, KareAccess organises evidence, exposes blockers and routes each claim through a transparent decision path.
- 01Ingest and organise
- 02Extract and cross-check
- 03Apply clinical, policy and tariff rules
- 04Route exceptions
- 05Recommend and record the decision
Business impact
Control leakage without slowing genuine claims
Reduce repeated reading, data entry and inter-team hand-offs.
Enable teams to handle substantially more claims by focusing effort on exceptions.
Surface non-payables, duplicates, excess billing, tariff variance and policy conflicts before approval.
Prioritise high-risk claims and preserve evidence for fraud investigation.
Human-led, AI-assisted
Automation that explains itself.
KareAccess provides recommendations, reasons, source references and exception trails. Final authority remains with designated reviewers under role-based access and auditable controls.
- Human approval for material decisions
- Traceable findings and reviewer actions
- Clear separation of user roles and data access
Secure access
Open your workspace
Use the portal assigned to your organisation.