HEALTHCARE
Healthcare claims, end-to-end, in hours instead of weeks.
From EDI intake to a ready-to-send EOB, SmartClaim runs every claim through a six-stage AI pipeline — clearing backlogs, catching fraud, and reserving human review for the claims that actually need it.
Healthcare
The problem we solve
Health plans, TPAs, and payer operations teams live with two crushing problems.
First, claim backlogs that delay provider payments and member care. Second, the steady drip of margin lost to fraud, duplicate billing, and coding errors that legacy systems were never built to catch. Adding more adjudicators doesn’t scale — and even when headcount grows, accuracy doesn’t improve with it.
SmartClaim takes claims from EDI intake to resolution automatically. Every claim runs through a six-stage AI pipeline — eligibility, code validation, fraud detection, duplicate scanning, payer-specific rules, and contracted pricing — and produces an EOB ready to send back. Only the genuinely complex claims ever reach a human reviewer.
Who Gets the Most Out of It
Hover any highlighted avatar to see what they get out of it
Outcomes Our Customers See
no human intervention needed for the majority of clean claims.
down from days under traditional workflows.
Real-time
Fraud Flags
ML models catch duplicate and anomalous billing as it arrives.
predictable throughput across every payer and claim type.
How It Works
Why SmartClaim
Most claims platforms speed up single stage eligibility checks, or fraud scoring, or pricing lookups and leave the rest of the pipeline as manual handoffs. SmartClaim runs all six stages as one automated flow, so a claim doesn’t just move faster through any one step it moves from intake to a finished EOB without waiting on a human at all, unless it genuinely needs one.
Common Questions
FAQ
SmartClaim is an AI-driven healthcare claims adjudication platform that takes claims from EDI intake through eligibility, code validation, fraud detection, duplicate scanning, payer-specific rules, and contracted pricing to a finished explanation of benefits.
Stop letting backlogs and billing errors eat your margin.
See how SmartClaim resolves claims in hours, catches fraud before payment goes out, and keeps providers paid on time.