Health claims automation for South-East Asian insurers and TPAs.
YIRA MedSense reads the medical reports, lab results, invoices and provider tariffs behind health claims for insurers, HMOs and TPAs in Indonesia, the Philippines, Malaysia, Thailand and Vietnam, 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 South-East Asian claims teams need a document layer.
Health insurance is expanding fast across South-East Asia through national schemes, private insurers, HMOs and employer plans, and claims volumes are growing with it.
Fast-growing volumes
More members and more providers mean more claim documents per reviewer.
Identity checks
Confirming the treated patient is the insured member is a recognised fraud control in the region.
Many document formats
Hospitals, clinics and labs each use their own layouts and price lists.
Fraud, waste and abuse
Reused documents and billing above agreed rates are hard to spot manually.
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 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 South-East Asian markets does MedSense support?
MedSense is available to insurers, HMOs and TPAs across South-East Asia, including Indonesia, the Philippines, Malaysia, Thailand and Vietnam.
Can MedSense verify the patient's identity?
Yes. It compares the member's ID photo with the photo taken at the hospital and returns a confidence level, a similarity score and image-quality checks for the reviewer.
How does MedSense help fight claims fraud?
It compares every new document with earlier records and flags matches for your investigators, alongside facial verification. It does not reject claims on its own.
Which documents can MedSense read?
Medical reports and histories (including handwritten notes), lab reports, invoices and provider tariffs, as scanned PDFs, digital PDFs or photos.
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.