Insurance claims, adjudicated
like an officer would — in 30 seconds.
Pre-auth. Final-bill adjudication. Reimbursement. Three workflows, one engine, one signed audit trail. Built for US payers, Indian TPAs, and the hospital networks that bill them.
Built for both
US and Indian payers.
Not a generic claims tool. Adjudo was trained on US plan documents (SBCs, EOCs, UB-04 bills), Indian policy schedules (IRDAI structure, NABH/non-NABH distinctions), and the actual deduction logic your reviewers apply.
Pre-authorization
- Hospital submits pre-auth with policy + diagnosis + estimated cost
- Adjudo matches to plan / SBC, applies network rates and sub-limits, returns approval / query
- Median 28 seconds vs. 4–6 hour human queue
In-network · Final bill
- On discharge, hospital pushes final bill (UB-04 or itemised) + discharge summary
- Adjudo re-adjudicates against approved pre-auth + new line items
- Flags scope creep, unbundling, room-rate overruns, out-of-network drift
Reimbursement
- Member uploads bill + discharge + investigations on portal
- Adjudo runs full adjudication: plan match, exclusions, deductible, coinsurance, copay
- Outputs an itemised settlement / EOB-style letter ready for ops review
The reviewer's day,
cut in half.
Watch a real claim go from
inbox to decision.
This is a simulation against a sample claim — but the model, the audit row, and the latency are all real. Hit Run to start.
What does Adjudo save
your team?
Move the sliders. Numbers update in real time. Conservative model: 80% adjudication-time reduction and 4-percentage-point leakage reduction (typical from our pilots).
Conservative · 80% time reduction · 4pp leakage reduction · $4.5k avg ticket
In pilot with payers and TPAs
across the US and India.
We're working with a small group of design partners under NDA. Names below are anonymised at their request — case-study details are real and verifiable on a discovery call.
Replaced manual pre-auth review with Adjudo on a 3-month pilot. Mean turnaround dropped from 4.5 hrs to 1.3 hrs; same reviewer count handled 6× the pre-auth queue.
Plugged Adjudo behind their inpatient claims pipeline. Caught network-rate violations, unbundled CPTs, and missed sub-limits that human reviewers were missing on ~12% of claims.
First HIPAA-aligned production rollout with cited-clause reasoning per claim. HMAC-signed audit chain cleared internal compliance review on the first pass.
Eval-grade. Not vibes.
Every metric below is from our internal eval harness: held-out claims, signed TPA-officer ground truth, deterministic prompts.
Be one of our first
design partners.
We're onboarding a small group of TPAs, insurers, and hospital networks. Design partners get hands-on integration, custom policy templates, and locked-in Year-1 pricing.
- 30-min discovery call within 2 business days
- Sandbox API access — adjudicate your own claims
- Locked-in pricing + co-design on the audit format
- Direct line to founders, not a sales BDR