Adjudicate any insurance claim
in 30 seconds.
The AI claims engine for US payers and Indian TPAs. Drop the policy + bill + discharge — get a signed, audit-grade decision with cited clauses. HIPAA-aligned for the US, IRDAI-grade for India. Every claim, every time.
Health claims are still
stuck in spreadsheets.
One claim = one policy + one bill PDF + one discharge note — whether you're a US payer or an Indian TPA. Every reviewer reads them line-by-line. The numbers below are why margins are tight and turnaround windows keep slipping.
From inbox to decision
in three steps.
Drop the docs
Policy / SBC, hospital bill (UB-04 or itemised), discharge summary, pre-auth letter. PDFs or photos — same flow your reviewers do today.
Adjudo adjudicates
Our Adjudo custom model — trained on thousands of US and Indian policies plus hospital discharge summaries — reads the policy, walks the bill line-by-line, applies deductibles, coinsurance, sub-limits, room caps, and exclusions. ~30 seconds, end-to-end.
Signed decision out
Approve / Approve-with-deductions / Query / Deny — with reasoning, cited clauses, and a tamper-evident HMAC audit row your compliance team will love. HIPAA-aligned for US, IRDAI-grade for India.
Watch a real claim go from
inbox to decision.
This is a simulation against a sample claim — but the model, the audit row, and the latency are all real. Hit Run to start.
Healthcare first.
Then motor, property, group.
One adjudication engine, many lines of business. Live in production for US + Indian health — every other vertical inherits the same audit-grade infrastructure.
Pre-auth, in-network adjudication, reimbursement — end-to-end. The full reviewer report your compliance team already writes, generated in 30 seconds with citations.
- Pre-auth, in-network, and reimbursement flows
- Deductibles, coinsurance, sub-limits, room caps applied automatically
- English + Hindi document support · UB-04 + itemised bills
- Signed audit trail · HIPAA-aligned (US) · IRDAI-grade (India)
- Drop-in REST API alongside Availity, Change Healthcare, or Indian TPA back-office
- Room-rent cap §3.2(a) — billed Deluxe ₹14,000/day vs. cap ₹8,000/day
- Pharmacy proportionate deduction §4.1 — flagged on 3 line items
- Copay §2.4 — 2% applied on net admissible
Built like an insurer expects.
Priced like a startup ships.
30-second adjudication
From upload to signed decision. The same flow your TPA officers do today, but model-assisted end-to-end.
Trained for both markets
Adjudo custom model — trained on thousands of US and Indian policies, hospital bills (UB-04, itemised), and discharge summaries. Beats GPT-4o on every quality metric.
HIPAA & IRDAI-grade audit
HMAC-signed, hash-chained audit rows. Tamper-evident, append-only — built to clear US payer audits and Indian regulator review.
Cited clause reasoning
Every deduction tied back to the policy clause that justifies it. No black-box decisions, no surprise denials.
Drop-in REST API
Sits behind your existing payer / TPA portal. JSON in, JSON out. No workflow rebuild — works alongside Availity, Change Healthcare, or any Indian TPA back-office.
Cloud or on-prem
Default cloud-hosted in US (us-east-1) or India (ap-south-1). Single-tenant on-prem available for payers with strict data-residency needs.
A custom model.
Not a GPT wrapper.
14 billion parameters, fine-tuned end-to-end on thousands of real US and Indian claim adjudications. We benchmarked it head-to-head against the frontier models you'd otherwise reach for. It wins on every metric that matters in claims work.
Every claim approved, denied, or partially approved with the same call your senior reviewer would make — measured against gold-label decisions written by working TPA officers, not a synthetic dataset.
Trained on real claims work
A private corpus of US plan documents (SBCs, EOCs, UB-04 bills) and Indian policy schedules with paired final bills + discharge summaries. The model learned the deduction logic your senior reviewers actually apply — sub-limit math, room-rate proration, unbundling, network rates, copay layering — not a generic LLM guessing from a prompt.
Schema-constrained decoding
Every decision is JSON-schema-locked at decode time via vLLM guided generation. No parse errors, no hallucinated fields, no missing line items. The model can't return malformed output even if it tries — the decoder physically can't emit invalid tokens.
Signed by construction
Each decision row carries a HMAC-SHA256 signature over (claim_id, prompt hash, output hash, timestamp), chained to the previous row. Append-only at the database layer. Tamper-evident on day one — HIPAA-aligned, IRDAI-grade, ready for your compliance team's first audit pass.
Cloud-hosted in us-east-1 / ap-south-1 · single-tenant on-prem available · never trained on customer claims
Beyond the verdict —
interrogate every claim.
Reviewers don't just want a decision. They want to ask why, cross-check against precedent, and pull up the last 50 similar claims in one click. Adjudo ships with both — claim-scoped chat, and a searchable memory of every adjudication you've ever done.
Ask the claim anything.
Every claim has its own chat thread that knows the policy, the bill, and the discharge. Streamed answers with inline citations, sub-second time-to-first-token.
Bill shows ₹14,000/day × 4 days in room rent. The policy caps single-room rent at ₹8,000/day under §3.2(a) — so ₹24,000 was disallowed and a proportionate deduction of ₹3,840 was applied to associated nursing charges.
- <600ms TTFT on warm prefix cache
- Every answer cites source clauses
- RAG-grounded · no hallucinations
- English + Hindi, switches mid-thread
Every claim, searchable forever.
Every adjudication Adjudo writes becomes searchable context. Find precedent, compare deductions, surface similar prior approvals — automatically inline with each new claim.
- Hybrid semantic + BM25 search
- Filter by hospital, plan, decision
- Inline "similar claims" on every adjudication
- Audit-grade · cites the original claim ID
In pilot with payers and TPAs
across the US and India.
We're working with a small group of design partners under NDA. Names below are anonymised at their request — case-study details are real and verifiable on a discovery call.
Replaced manual pre-auth review with Adjudo on a 3-month pilot. Mean turnaround dropped from 4.5 hrs to 1.3 hrs; same reviewer count handled 6× the pre-auth queue.
Plugged Adjudo behind their inpatient claims pipeline. Caught network-rate violations, unbundled CPTs, and missed sub-limits that human reviewers were missing on ~12% of claims.
First HIPAA-aligned production rollout with cited-clause reasoning per claim. HMAC-signed audit chain cleared internal compliance review on the first pass.
Eval-grade. Not vibes.
Every metric below is from our internal eval harness: held-out claims, signed TPA-officer ground truth, deterministic prompts.
Be one of our first
design partners.
We're onboarding a small group of TPAs, insurers, and hospital networks. Design partners get hands-on integration, custom policy templates, and locked-in Year-1 pricing.
- 30-min discovery call within 2 business days
- Sandbox API access — adjudicate your own claims
- Locked-in pricing + co-design on the audit format
- Direct line to founders, not a sales BDR