Health claims document automation for US health plans and TPAs.
YIRA MedSense reads the medical records, itemized bills, lab reports and discharge summaries behind health claims, appeals and medical reviews, turns them into structured data, checks the patient's identity and flags documents that match earlier claims, so claims, clinical and SIU teams review faster.
Medically reviewed by Dr. N. S. Santosh Varma, MBBS, FIIM, FIDM, FICCM · Medical Officer, YIRA MedSense · Updated 27 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 US claims teams need a document layer.
US health plans and third-party administrators for self-funded employer plans handle high volumes of medical records attached to claims, appeals, prior authorizations and audits.
Medical record review
Clinical reviewers read long records to support medical necessity and appeal decisions.
Itemized bill review
Bill lines need checking against what the records show and what was agreed.
Fraud, waste and abuse
SIU teams look for reused documents and identity substitution across claims.
Privacy
Protected health information must be handled to HIPAA requirements.
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, care management or SIU systems by API, alongside your existing adjudication and payment workflows.
| 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
Does MedSense replace our claims or adjudication platform?
No. MedSense reads and checks the medical documents behind claims and sends structured data to your existing systems by API. Adjudication and payment stay in your platform.
Is MedSense HIPAA compliant?
Yes. MedSense is HIPAA compliant and also supports client-managed deployment, so documents can stay inside your own environment.
Which documents can MedSense read?
Medical records, itemized bills, lab reports, discharge summaries and handwritten notes, as scanned PDFs, digital PDFs or photos.
Can MedSense support SIU and payment integrity teams?
Yes. It compares every new document with earlier records, checks the patient's face against the ID photo, and flags matches for investigators. It does not deny claims on its own.
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.