AI workflow automation for clinical referral and claims document triage
Intelligent OCR extraction, fraud pattern detection and automated adjudications.
- Client
- National Health Insurer
- Healthcare Claims & Third-Party Administrator (TPA)
- Location
- New Delhi & Vadodara
- Timeline
- 14 weeks from dataset annotation to full production integration
- Headline result
- 70%
- Less manual paperwork and data entry
Overview
A national health TPA received over 35,000 scanned clinical discharge summaries, hospital bills, and diagnostic reports each week. Teams of medical coders manually transcribed doctor notes and invoices into billing systems. Nexasoft developed an AI document extraction pipeline with human-in-the-loop review that automated 70% of intake volume.
The challenge
- Inbound discharge summaries with inconsistent layouts, poor scans, and handwritten prescriptions.
- Average claim adjudication cycle took 9 working days, creating backlog during epidemic spikes.
- High human fatigue causing transcription errors and incorrect tariff code applications.
- Stringent patient privacy regulations prohibiting raw clinical text storage on public cloud AI APIs.
What we built
- Trained custom on-premise vision and OCR models optimized for Indian medical bills and pharmacy receipts.
- Built automated ICD-10 medical coding mapping and hospital package tariff cross-verification.
- Designed an ultra-clean triage workbench highlighting low-confidence fields for rapid human verification.
- Connected directly to insurer core claims engines via secure webhook dispatches.
Results
- Reduction in manual medical transcription and entry paperwork
- 70%
- Claims adjudication cycle reduced from 9 days to under 3 days
- 3 Days
- Accuracy on medical bill line items and diagnostic tariff mapping
- 98.2%
- Throughput capacity increase without expanding administrative staff
- 4x
Architecture
- Python AI/ML service pipeline with FastAPI and PyTorch models.
- Secure on-premise GPU inference cluster ensuring clinical data remains within protected VPC.
- React document review workbench with dual-pane PDF viewing and inline corrections.
- PostgreSQL and RabbitMQ for asynchronous claim processing and priority scheduling.
“The accuracy of Nexasoft's document extraction engine exceeded our expectations. Our medical adjudication team now focuses purely on complex exceptions rather than manual typing.”
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