Health claims automation for African HMOs and insurers.
YIRA MedSense reads the medical reports, lab results, invoices and provider tariffs behind health claims for HMOs, insurers, medical schemes and TPAs across Africa, including Nigeria, Kenya and South Africa, turns them into structured data, checks the patient's identity and flags documents that match earlier claims.
Medically reviewed by Dr. N. S. Santosh Varma, MBBS, FIIM, FIDM, FICCM · Medical Officer, YIRA MedSense · Updated 13 October 2026
{
"documents": ["medical_report.pdf", "invoice.pdf", "lab_report.pdf"],
"extracted": "diagnoses, ICD-10 codes, drugs, lab values, bill lines",
"identity_check": "ID photo vs hospital photo, confidence score",
"prior_record_match": "flag if fields match an earlier claim",
"output": "structured JSON to your claims system"
}Illustrative output. MedSense prepares the review; your claims system handles submission.
Why African claims teams need a document layer.
Health cover is growing across Africa through HMOs, medical schemes, private insurers and national programmes, and much of the claims evidence is still on paper.
Paper-heavy claims
Many providers still send handwritten notes, scanned reports and paper invoices.
Growing membership
Expanding cover means more claims for the same review teams.
Fraud, waste and abuse
Reused documents, identity substitution and billing above agreed tariffs drain funds.
Many provider formats
Every hospital, clinic and lab uses its own layout and price list.
The document layer behind every claim.
MedSense does not replace your claims platform or your regulator submissions. It reads the medical documents that sit behind each claim, so your team reviews structured data instead of scans. Structured output goes to your claims or HMO management system by API.
| Step | Without MedSense | With MedSense |
|---|---|---|
| Document intake | Scans and PDFs read by hand | Medical reports, lab reports, invoices and tariffs read by OCR and clinical NLP into JSON |
| Medical review | Reviewer reads every page | Diagnoses, ICD-10 codes, drug names and lab values flagged against their ranges |
| Identity | Visual check of an ID copy | ID photo compared with the hospital photo, with a confidence score |
| Fraud, waste and abuse | Found late, in audits | New documents matched against prior records; matches flagged for investigators |
| Provider pricing | Manual tariff lookup | Provider tariffs as procedure-level rate tables, contract rules applied, missing rates shown as NA |
Already in production at scale.
MedSense runs in production at Health Assist Insurance TPA Pvt Ltd in India. It has parsed more than 1 lakh (100,000+) medical documents, flagged over 5,000 fraud cases for review and supported 100+ insurance operations.
Sandbox
Test MedSense on your own sample claim documents.
Provision
Set up document types, fields and rules for your portfolio.
Integrate
Connect by API to your claims or TPA system.
Go live
Run in parallel, then switch over.
Timing depends on scope, data access and integration readiness. Client-managed deployment is available, so MedSense can run inside your own infrastructure. A field match is not a fraud determination; your team decides.
Questions from claims teams
Which countries in Africa does MedSense support?
MedSense is available to HMOs, insurers, medical schemes and TPAs across Africa, including Nigeria, Kenya and South Africa. It reads standard medical documents and ICD-10 codes.
Can MedSense read handwritten medical notes?
Yes. Handwritten medical histories and questionnaires are converted into structured fields that reviewers can search.
How does MedSense help fight claims fraud?
It compares every new document with earlier records, checks the patient's face against the ID photo, and flags matches for your investigators. It does not reject claims on its own.
Can MedSense check bills against provider tariffs?
Yes. Provider tariffs become procedure-level rate tables with your contract rules applied, so bill lines can be checked against the agreed rate.
Can MedSense run inside our own infrastructure?
Yes. Client-managed deployment is available, so documents can stay within your environment. Hosting and data residency are agreed per contract.
Is MedSense already used by insurers or TPAs?
Yes. Health Assist Insurance TPA Pvt Ltd uses MedSense in production, where it has parsed more than 100,000 medical documents.
How long does a rollout take?
About 4–5 weeks from sandbox to go-live, depending on scope, data access and integration readiness.
Can MedSense detect forged or edited documents?
Tampering and forgery checks can be built for your requirements as a scoped custom module. They are not part of the standard product today.
Book your demo today.
See MedSense on the documents and fields that matter to your claims team.