01Claims47 · Health Insurance
Medical bills shouldn't mean a bigger review team.
Automate the reimbursement of health claims, from a pharmacy receipt to a hospital bill: extraction, coding, fraud screening and pricing against your benchmarks or tariffs, with control over every decision.
02Claims47 · Product definition
Specialized AI for health reimbursement.
Claims47 reads the bills your systems can't process automatically (consultations, hospital stays, pharmacy, dental, cross-border or paper-born), codes them, prices every line against your benchmarks or tariffs, and turns them into payment-ready reimbursement or repricing decisions, whether the payee is the member or the provider.
Any bill, any format
Invoices, receipts, medical reports, discharge summaries, claim forms and photos, extracted and structured.
Coding & benchmarks
ICD-10/CPT assigned or validated, every line priced against your benchmarks, fee schedules or tariff catalog.
Decision or review
Routine bills resolve straight-through; anything above benchmark is prepared for analyst sign-off.
03Claims47 · The tension
More automation shouldn't mean less control over what you pay.
Manual bill review
Catches the judgment calls, but analyst time scales one-to-one with volume and works on samples.
Basic OCR + rules
Extracts fields, but can't code, price against benchmarks or screen every bill for duplicates and anomalies.
Nothing above benchmark goes through silently, and nothing clean waits for an analyst.
04Claims47 · Proven in production
In a live US-administered health plan, Claims47 takes bills from portal intake to a payment-ready EDI file: eligibility, documents, coding and repricing.
Under a minute end to end. Zero manual re-keying. Every bill screened.
Cost
Up to 80%of the process automated end to end. Your analysts keep only the judgment calls.
Time
60sfrom a complete claim to a payment-ready decision.
Trust
100%of bills screened for leakage: forensics, duplicates, patterns.
From a deployment in production
medical claims per month
from portal intake to payment-ready EDI
ICD-10 / CPT coding accuracy
claims handled per adjuster, per day, in the first weeks of production (40-50 → 100)
Figures from a US-administered international health plan running Claims47 in production, first months of ramp-up. Reference available under NDA. Every demo runs on synthetic data.
05Claims47 · Specialization
Built for the bills nobody's system reads.
Member reimbursement and provider bills · ICD-10 / CPT · benchmarks and tariffs · fraud and duplicates.
Heterogeneous bills
Member receipts, out-of-network, cross-border and paper-born bills that no structured system reads. Our edge starts where 837 auto-adjudication ends.
ICD-10 / CPT coding & validation
Uncoded bills coded; provider-coded bills validated line by line.
Benchmarks & fee schedules
Every line priced against your benchmarks, RBP references or contracted schedules.
Fraud & duplicates
Altered documents, duplicate submissions and provider billing patterns caught before payment.
06Claims47 · Operational fit
Works with your existing systems and EDI flows.
No core replacement. Configurable benchmarks and thresholds, analyst sign-off where you decide, HIPAA-ready from day one.
- Portal, EDI 837/835 and legacy systems
- Runs in M47 Cloud: AWS with a signed BAA, SOC 2
- Configurable benchmarks and thresholds
- Analyst sign-off where you decide
- Full audit trail on every decision
- HIPAA-ready · ISO 27001 since 2021
07Claims47 · How it works
From a scanned bill to a payment-ready decision.
Intake → extraction → eligibility → coding or validation → benchmark pricing → fraud screening → decision or analyst review. Each capability owns one step and hands a traceable output to the next.
Detected type
— · the claim type is detected from the customer's own words, with a confidence scoreDecision
Press Run live demo to watch the claim processed check by check.
Product view. Synthetic data.
Intake & triage
Reads any claim documentation (invoices, receipts, reports, discharge summaries, forms, photos), structures every field, flags gaps and duplicates.
DocFraud47
Pixel-level forensics plus billing-pattern analysis across claims and providers, before any decision.
Evidence
Codes or validates ICD-10/CPT, prices every line against benchmarks or tariffs, delivers reimbursement or repricing decisions.
Communication
Keeps members and providers informed and chases missing documentation automatically.
Insights
Reviews up to 100% of decided claims: price outliers against benchmarks, provider billing patterns, portfolio trends.
08Claims47 · Why Claims47
Why insurers, TPAs and payers pick it.
Built for heterogeneous bills · proven on US medical claims · HIPAA-ready · faster than building internally.
Built for heterogeneous bills
Our edge starts where 837 auto-adjudication ends: the bills nobody's system reads.
Proven on US medical claims
A US travel-medical TPA and a US-administered health plan, in production.
HIPAA-ready from day one
Runs in M47 Cloud on AWS with a signed BAA, connected securely to your portal and EDI flows. ISO 27001 since 2021, SOC 2.
Faster than building internally
Configured for fast pilots on your benchmarks and fee schedules, live in weeks.
09Claims47 · Next step
Watch a bill like yours become a payment-ready decision, live
20-minute demo on synthetic data. Then we show how your benchmarks, fee schedules and rules plug in. No integration, no commitment.
Claims47 · an M47 Labs solution · Runs in M47 Cloud · ISO 27001 · SOC 2 · GDPR compliant · HIPAA-ready · BAA for US payers · setup fee + price per claim · References available under NDA