The Process
From discharge to settlement
Care.Fi connects claims coding, rejection scoring before submission, and gap financing for claims that remain pending beyond 14 days.
Claims from discharge to settlement
Discharge
Hospital EMR sends discharge files in PDF or HL7.
Claim AI
Care.Fi reads the discharge summary, maps codes, and prepares the claim.
Pre-check
The model scores each claim from 0 to 100. Claims above 65 receive a remediation checklist.
Financing
Claims pending >14 days auto-qualify. Care.Fi advances up to 80% within 48 hours.
Step 1
Automated claims filing
Care.Fi reads discharge summaries from your hospital information system in PDF or HL7 format. It maps diagnosis and procedure codes to ICD-10 and NABH-standard procedure codes, then submits the claim to the insurer or TPA through an API or portal automation.
The billing team gets a formatted claim ready for API or portal automation, with no manual re-entry.
| Field | Extracted Value | Status |
|---|---|---|
| Diagnosis | Type 2 Diabetes w/ Neuropathy | Mapped |
| ICD-10 | E11.40 | Confirmed |
| Procedure | Nerve Conduction Study | Mapped |
| CPT Equiv. | 95905 | Confirmed |
| TPA Format | MEDI-ASSIST v3 | Ready |
Step 2
Rejection risk scoring
Before submission, Care.Fi's model scores each claim from 0 to 100 for rejection risk. The score helps your billing team identify claims that need review.
Claims scoring above 65 receive a remediation checklist showing which items need correction. Your billing team fixes flagged items before submission.
Step 3
Gap financing for claims
Once a hospital enrolls, claims pending >14 days auto-qualify. Care.Fi advances up to 80% of face value, typically within one business day and within 48 hours.
When the insurer settles the claim, repayment happens automatically. The advance is tied to the claim and ends at settlement.
Hospitals enroll once. Claims pending >14 days auto-qualify, with repayment automatic at insurer settlement.