The Complete Claims Decision & Loss Prevention Suite
Eight specialized, production-ready modules engineered to transform messy healthcare documentation into explainable, auditable adjudication decisions.
8 Pillars of Claims Intelligence
Deploy individual modules or the entire end-to-end adjudication pipeline integrated with your core PAS.
ClaimSense™ Decision Engine
Multimodal parsing of handwritten notes, itemized bills, and lab scans. Generates complete evidence cards with transparent rupee adjustments.
FraudGraph™ Ring Explorer
Graph neural network engine that maps multi-entity linkages across doctors, diagnostic labs, hospitals, brokers, and patients to detect organized fraud rings.
DocForensics™ Image Forensics
Sub-pixel forensic inspection of submitted PDF bills, discharge summaries, and medical imaging. Identifies font modifications and digital signature tampering.
ProviderIQ™ Benchmarking
Continuously benchmarks hospital billing distributions, length of stay, and procedural anomaly rates against specialty peers in the same geographic region.
TariffGuard™ Contract Audit
Sub-second line-item comparison against negotiated hospital tariff agreements. Detects unbundled consumables (stents, catheters, OT packs) in real time.
PolicyMind™ Clause Extraction
Instantly extracts room rent limits, pre-existing disease (PED) waiting periods, day-care exclusions, and copay requirements without manual reading.
ClaimCopilot™ AI Assistant
Conversational assistant allowing claims adjudicators to query complex 50-page hospital dossiers with instant, evidence-grounded answers.
PortfolioRisk™ CFO Ledger
Macro-level financial dashboard tracking preventable leakage, recovery conversion rates, false-positive precision, and net portfolio loss-ratio impact.
Integrates with Your Existing Core Insurance Stack
LiceronTech operates non-destructively alongside Guidewire, SAP Insurance, Instanda, MediAssist, Vidal Health, or custom PAS portals.
1. Real-Time REST & Webhooks
Trigger adjudication pipelines synchronously via JSON REST APIs or asynchronously via webhook callbacks upon document upload.
2. FHIR & ABDM Compliant
Native support for FHIR R4 diagnostic report bundles, ABHA consent tokens, and ROHINI / NMC registry lookup connectors.
3. On-Premises or Private Cloud
Deploy via containerized Kubernetes charts directly inside your secure private AWS / Azure India VPC or air-gapped on-prem datacenter.
Ready to Evaluate the Suite on Your Historical Claims?
Run a confidential retrospective pilot on 1,000 anonymized claims to benchmark recoverable leakage.