TPA claims processing software that reads every medical document.
YIRA MedSense is AI claims-document software for third-party administrators worldwide, from India and the Gulf to Africa, South-East Asia, Europe and the US. It reads the medical histories, lab reports, bills and hospital tariffs that arrive with every cashless and reimbursement claim, turns them into structured data, confirms the admitted patient is the insured person, and flags documents that match earlier claims.
Medically reviewed by Dr. N. S. Santosh Varma, MBBS, FIIM, FIDM, FICCM · Medical Officer, YIRA MedSense · Updated 12 October 2026
{
"document": "lab_report.pdf",
"tests": [
{ "name": "ALT", "value": 52.19, "unit": "U/L", "flag": "High" },
{ "name": "ALP", "value": 236, "unit": "U/L", "flag": "High" }
],
"flag_basis": "report reference range",
"next": "medical officer review"
}Sample output. Values flagged against the lab's own reference range.
Why TPA claims teams struggle with documents.
A TPA anywhere in the world processes claims for many insurers and thousands of network hospitals, and almost every claim arrives as a bundle of documents in different formats.
Handwritten histories
Doctor notes and medical histories that someone has to read and key in by hand.
Hundreds of lab formats
Every lab has its own layout and its own reference ranges.
Bills vs tariffs
Different room categories and package rates for every hospital in the network.
Recycled documents
Repeat documents are hard to spot when every file is reviewed on its own.
The result: slow pre-authorisation, long reimbursement queues and claim leakage that only shows up in audits.
What MedSense does for a TPA.
| Claims step | Without MedSense | With MedSense |
|---|---|---|
| Pre-auth and claim intake | Staff read scans and type fields | Documents arrive by API, mobile app or bulk scanner portal; fields are extracted to JSON |
| Medical review | The doctor reads the full file | Structured history, diagnoses, ICD-10 codes, drug names and lab values flagged against the report's own range |
| Patient identity | Visual check, if at all | ID photo compared with the hospital photo; confidence score shown to the reviewer |
| Fraud and duplicates | Found late, in audits | Every new document matched against prior records; matches flagged for investigators |
| Bill vs tariff | Manual lookup per hospital | Hospital tariffs as procedure-level rate tables, contract rules applied by room category, missing rates shown as NA |
| Hand-off | Re-keying into the claims system | Pushed to your TPA portal, insurer systems, hospital EMR or analytics database |
Four stages, one structured claim file.
Ingest
API, mobile app or bulk scanner portal: scanned PDFs, handwritten notes, lab reports and mobile photos.
Understand
Medical-grade OCR and clinical NLP pick out ICD-10 codes, drug names (NLEM), patient demographics and billing line items.
Validate
Review checks and standardisation, so every hospital's document looks the same to your team.
Integrate
JSON and APIs into TPA portals, insurance systems, hospital EMRs and analytics databases. Client-managed deployment available.
What your medical officers actually see.
- Handwritten history → structured Q&A. A handwritten medical history becomes searchable question-and-answer fields.
- Lab values flagged. For example ALT 52.19 U/L and ALP 236 U/L marked High against the lab's own reference range.
- Prior-record match. 16 of 17 fields matched, with 4 prior matches, sent to an investigator for review.
- Facial verification. ID photo compared with the hospital photo, with a confidence score.
A confidence score is not validated accuracy, and a field match is not a fraud determination. Your team decides.
Built for every role in a TPA.
Head of claims
Shorter turnaround on cashless and reimbursement claims.
Medical officers
A clean, structured file instead of a stack of scans.
Fraud and investigation
Repeat documents and identity mismatches surfaced early.
Provider network
Hospital tariffs as comparable rate tables.
CTO / IT
APIs, JSON and client-managed deployment. No rip-and-replace of your claims system.
In production at Health Assist Insurance TPA.
Health Assist Insurance TPA Pvt Ltd runs MedSense in production. Across insurance operations MedSense has parsed more than 1 lakh medical documents and flagged over 5,000 fraud cases for review.
Sandbox
Try MedSense on your own sample documents.
Provision
Set up your environment, document types and fields.
Integrate
Connect to your claims system by API.
Go live
Run in parallel with your current process, then switch over.
Timing depends on scope, data access and integration readiness. Commercials: a paid pilot of defined scope, then an annual platform commitment plus usage. White label and partner API are available for claims-software vendors.
Questions from claims teams
What is TPA claims processing software?
Software a third-party administrator uses to receive, review and settle health insurance claims on behalf of insurers, from pre-authorisation and document review to approval and payment. YIRA MedSense adds the document-intelligence layer: it reads the medical documents and feeds structured data into the TPA's existing claims system.
Does MedSense replace our claims system?
No. It sits between incoming medical documents and your claims system and connects by API, so your current workflow keeps running.
Can it handle cashless pre-authorisation as well as reimbursement claims?
Yes. It reads the same document types for both: medical histories, lab reports, bills and hospital tariffs.
Can MedSense read handwritten doctor notes?
Yes. Handwritten medical histories are converted into structured question-and-answer fields.
How does MedSense help with claim fraud at a TPA?
It matches every new document against earlier records and checks the patient's face against the ID photo, then flags matches for your investigators. It does not reject claims on its own.
How long does implementation take?
About 4–5 weeks from sandbox to go-live, depending on scope, data access and integration readiness.
Where is our claims data processed?
MedSense supports client-managed deployment, so it can run inside your own infrastructure and documents stay within your environment. Hosting, data residency and access controls are agreed per contract, and Yira is ISO 9001:2015 certified and SOC 2, HIPAA and GDPR compliant.
Which countries does MedSense work in?
MedSense works with TPAs and health insurers worldwide. It reads standard medical documents and ICD-10 codes, is in production in India, and is available for TPAs and insurers in the Gulf, Africa, South-East Asia, Europe and the Americas.
Who is already using MedSense?
Health Assist Insurance TPA Pvt Ltd uses MedSense in production. MedSense has parsed more than 1 lakh medical documents across 100+ insurance operations.
Book your demo today.
See MedSense on the documents and fields that matter to your claims team.