The claims engine your claims officers actually trust.
IRDAI-grade. NABH-aware, NPPA-priced. Cited and signed on every decision. Built for Indian health insurers who can't afford another black-box AI vendor — from Star Health and Niva Bupa to HDFC Ergo, Care Health and ICICI Lombard.
The pain we hear, every week.
Cashless approval queues
Claims officers spend 12–18 minutes per cashless pre-auth on policy-wording lookup alone. Adjudo hands it back with the cited policy clauses, NABH tariff and NPPA caps already attached.
Sub-limit and NPPA leakage
Room-rent caps, proportionate deductions, disease sub-limits and NPPA price ceilings get missed at the desk — and the money leaks out. A constrained-decoded model applies every clause the same way, on every claim, each one cited.
IRDAI audit defensibility
When IRDAI, an Ombudsman, or a policyholder's counsel asks why — you need the cited policy wording, the prompt that produced the decision, and a tamper-evident signature. We give you all three on every adjudication.
Disputes with hospitals
When a network hospital pushes back on a deduction, your officer has minutes to defend it. Cited clauses plus NABH and NPPA references on every Adjudo decision means the answer is already written.
How it fits your workflow.
Connect your claims feed
Pre-auth requests, final bills and discharge summaries come in via API or a secure SFTP drop. We work with your existing policy master, network tariffs and claim IDs.
Shadow mode for 1–2 weeks
We adjudicate everything in parallel without enforcing. Your team reviews decisions, gives us feedback, and we tune.
Assist or auto
Move to assist mode (every decision reviewed before payment) or auto mode (low-risk cashless claims through, edge cases routed to senior officers).
Audit on demand
Any decision can be re-played from its prompt SHA-256 and model version. Hash-chained signatures prove nothing was modified after the fact.
Frequently asked.
We meet IRDAI's audit-trail expectations: an append-only adjudication ledger, 8-year retention, signed and hash-chained, with full prompt + model version provenance. ISO 27001-aligned; DPA available on Growth and Enterprise. Policyholder data stays inside your tenant.
Yes. NABH tariffs are encoded as policy clauses, ICD-10 coding and bundling logic are modelled alongside your policy wordings, and NPPA price caps are enforced at the line-item level. The model is fine-tuned on real Indian adjudication patterns.
We've integrated with the major Indian health-claims and TPA platforms as well as home-grown systems. Claims in, decisions out, with the audit trail attached as a sibling artifact.
Adjudo emits a calibrated confidence score per decision. Below your configurable threshold, the claim is routed to a human with the model's reasoning + cited clauses pre-loaded.
Want to see it on a real claim?
Send us one (de-identified). We'll adjudicate it live and walk you through the decision.
Talk to us →