Health claims automation for Saudi insurers and TPAs.
YIRA MedSense reads the medical reports, lab results, invoices and provider tariffs behind every health claim in Saudi Arabia, turns them into structured data, checks the patient's identity and flags documents that match earlier claims, so claims teams review faster and fraud is caught before payment.
Medically reviewed by Dr. N. S. Santosh Varma, MBBS, FIIM, FIDM, FICCM · Medical Officer, YIRA MedSense · Updated 12 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 Saudi claims teams need a document layer.
Saudi Arabia's health insurance market is regulated by the Council of Health Insurance (CHI), and claims move through the national NPHIES platform. The medical documents behind each claim still need to be read and checked.
National e-claims
NPHIES standardises how claims and eligibility move between providers and payers, but supporting documents still need review.
Fraud focus
The regulator has publicly announced plans for stronger measures against health insurance fraud.
Large provider networks
Many hospitals and clinics, each with its own reports, invoices and price lists.
Growing volumes
Mandatory cover for employees and residents means steady growth in claims per reviewer.
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 system by API, which keeps handling NPHIES submission and responses.
| 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 connect to NPHIES?
MedSense does not submit claims itself. It reads and checks the medical documents and sends structured data to your claims system by API, and your existing platform keeps handling NPHIES transactions.
Which documents can MedSense read for Saudi claims?
Medical reports and histories (including handwritten notes), lab reports, invoices and provider tariffs, as scanned PDFs, digital PDFs or photos.
How does MedSense help Saudi insurers 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 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 in India, 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.