AI Studio · Healthcare clinics
Insurance claim processing automation for hospitals and clinics
Every insured admission means paperwork with a TPA or insurer at three moments: pre-authorisation at admission, enhancement when the stay changes and final claim at discharge. Each step needs the right forms, clinical notes and bills, uploaded to a different portal. Finaley AI Studio assembles and submits these files from your hospital records, tracks every query and keeps doctors and the insurance desk in charge of what is sent.
Cashless claims stall on missing papers
The insurance desk juggles many TPA and insurer portals, each with its own forms and document rules. A pre-authorisation request goes in without the investigation reports, so a query comes back. Enhancement requests are late because the treating doctor's note was never scanned. At discharge, patients wait for hours while the final bill, discharge summary and implant invoices are collected. Deductions and rejections then arrive weeks later, and reimbursement files sit incomplete in a cupboard.
How the automation runs
- 1
Open the claim at admission
AI agentThe agent reads the patient's policy card, ID and admission notes, identifies the TPA or insurer and starts the pre-authorisation form on the right portal.
- 2
Assemble supporting documents
AI agentIt attaches the doctor's notes, investigation reports, estimate and ID documents your desk normally sends, and lists anything still missing.
- 3
Doctor and desk approve
Professional checkThe treating doctor confirms the clinical details and the insurance desk checks amounts and codes before any request is submitted.
- 4
Track queries and enhancements
AI agentIt watches the portals and email for queries, prepares replies with the requested papers, and drafts enhancement requests when the treatment plan changes.
- 5
Compile the discharge file
AI agentAt discharge it gathers the final bill, discharge summary, pharmacy and implant invoices into the format each TPA expects and submits after approval.
- 6
Follow settlement
AI agentIt records settlement amounts, lists deductions against the bill and flags short payments or rejections for your billing team to dispute.
Works across TPA portals and your HMS
Finaley works in your hospital management system and in the TPA and insurer portals your desk logs into today, through the screens the way your staff do. Bills, notes and reports come from your HMS or scanned files. No new software is introduced, and Finaley has no special arrangement with any insurer or TPA.
Clinicians and billing staff sign off
Medical details in a claim must be accurate, so the treating doctor approves every clinical statement and the insurance desk approves amounts. The automation prepares and tracks; it does not decide coverage, alter diagnoses or argue a claim on its own.
What you get
- Pre-authorisation requests sent with the full set of documents
- Queries answered without searching for files
- Discharge files ready when the final bill is
- Deductions listed for your billing team to review
Questions
Does it cover both cashless and reimbursement claims?
Yes. For cashless cases it handles pre-authorisation, enhancement and discharge submission. For reimbursement, it assembles the document set and certificates the patient needs to file with their insurer, so the file leaves your hospital complete.
Which TPAs and insurers can it work with?
It works through whichever portals and email channels your insurance desk uses today, the same way your staff do. We do not claim any partnership with insurers or TPAs. During setup we test it against your recent claims on each portal.
Who decides what clinical information is sent?
The treating doctor. The automation pulls notes and reports from your records and drafts the request, but a clinician confirms the medical details and the insurance desk confirms the amounts before anything is submitted. Nothing leaves the hospital without both approvals.
Will it reduce claim deductions?
We do not promise outcomes that depend on insurers. What it does is make sure each submission carries the documents your desk would normally send, replies to queries promptly, and lists every deduction so your team can decide which ones to contest.
What do we need to get started?
A walkthrough of how your insurance desk handles an admission from start to settlement, plus access to the portals they use. We build the process, test it on past claims until it matches your desk's work, then run it on new admissions.
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Show us how your team does it.
Send a screen recording or book a call. We build it, test it on your past work, and only switch it on when the results match your team's.