AI powered invoice reception
Invoices and clinical documents in any format, paper, PDF or electronic, read into clean structured data. No manual keying, no transcription risk.
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Solution profile
Health Insurance Risk Management
MedicalBytes administers health risk from the moment a policy is signed to the moment a provider is paid. It is built as a single linear chain: nothing enters unverified and nothing leaves unrecorded.
MedicalBytesby SeptiBytes
11connected pillars, one chain
The problem
Cover does not fail loudly. It leaks quietly
Very little of the loss in a health benefit pool comes from one dramatic event. It accumulates, a few percent at a time, in places that are individually defensible and collectively expensive.
Members who are not who they say they are
Cards are shared, dependants age out, terminations arrive late
Benefits tracked outside the system
Sub limits on spreadsheets, so the limit is known after it is exceeded
Invoices keyed by hand
Every manual capture is a transcription risk and a payment delay
The rulebook applied unevenly
Two assessors, two answers, and a variance nobody can price
Architecture
The eleven pillars
The sequence matters. The integrity of the final payment depends on the integrity of every step before it.
01
Role based access control
Permissions by role, scoped by client and branch
02
Network and client management
One source of truth for who we pay and who pays us
03
Policy and membership
Smart onboarding to correctly entitled members
04
Biometric identification
Fingerprint and face verification at the point of service
05
Table of benefits engine
Every benefit and sub limit, consumption tracked live
06
Automated pre authorisations
Cover, clinical fit and affordability decided up front
07
AI powered invoice reception
Any format converted to clean, coded, validated data
08
Claims adjudication and audit
Full rulebook per line, continuous audit for abuse
09
ICD10 and CPT coding engine
Diagnosis, billed activity and tariff always agree
10
Automated payment runs
Accurate, reconciled, properly approved settlement
11
Dynamic reporting
Live operational control and insight per stakeholder
One linear chain
Nothing enters unverified and nothing leaves unrecorded. Request a walkthrough →
Who it is for
Three buyers, three problems
Third party administrators
Administer more lives with the same desk. Straight through adjudication on the clean majority, exceptions routed by reason code, and defensible variance on every claim.
Hospitals, pharmacies and clinics
Know you will be paid before you treat. Biometric verification and a live benefit check at the front desk, pre authorisation decided up front, fewer rejections at submission.
Insurers and schemes
See the risk while you can still price it. Live loss ratio and utilisation, leakage isolated by cause, and product design evidence from real consumption.
3checks before any claim is trusted
Verification
Prove the person, then trust the claim
Everything downstream, authorisation, adjudication and payment, is only as trustworthy as this step. It is deliberately the hardest thing in the platform to bypass.
Biometric identification
Fingerprint and face verification at the point of service, in seconds
Live entitlement
Membership, dependants, waiting periods, exclusions and terminations resolved at the moment of the check
Consumption in real time
Every benefit and sub limit checked against what has already been used
Processing
From any invoice to a reconciled payment
ICD10 and CPT coding engine
Authoritative clinical coding so the diagnosis, the billed activity and the contracted tariff always speak the same language.
Automated payment runs
Adjudicated claims turned into accurate, reconciled payments, with approval ceilings and segregation of duties enforced.
Tariff sets, scheme rules and provider contract terms are loaded per client, so the engine adjudicates against your rulebook rather than a generic one.
Implementation
How we get you live
- 01
Discovery
Your rulebook, plans, tariffs, providers and current systems mapped.
- 02
Configure
Benefits, sub limits, rules and roles loaded. Your rulebook, not a template.
- 03
Integrate
Membership, provider, finance and clinical system interfaces built and tested.
- 04
Parallel run
Live claims processed in both systems and reconciled before you switch.
- 05
Cutover
Staged, with a rollback plan, then training and hypercare support.
Licence
Per member per month, tiered by volume across the book.
Implementation
Once off, scoped after discovery so the number reflects your rulebook, not an average.
Integration and support
Priced per interface, then a monthly support window with a defined response time.
Third party administratorsMedical schemes and insurersHospital groupsPharmaciesClinics and day facilities
