Platform Overview
Three products, one claims lifecycle
Care.Fi covers the claims journey from creation to settlement. Use each module independently or connect them as one workflow.
Module 1
AI Claims Engine
The AI Claims Engine ingests discharge summaries in PDF or HL7 format. Its transformer-based model maps clinical details to ICD-10 and NABH procedure codes, then submits the claim to a TPA or insurer via API.
The engine prepares each claim for TPA or insurer submission through API, giving billing teams a clear view as claims move toward settlement.
- PDF and HL7 intake
- ICD-10 and NABH code mapping
- TPA and insurer API submission
- Claim status tracking
| Claim ID | Insurer | Amount | Status |
|---|---|---|---|
| CFI-10842 | Star Health | ₹84,200 | Settled |
| CFI-10843 | HDFC Ergo | ₹1,12,500 | Under Review |
| CFI-10844 | ICICI Lombard | ₹43,800 | Submitted |
Module 2
Rejection Predictor
Before submission, the Rejection Predictor checks claim content and scores the claim from 0 to 100. It identifies risk factors that may lead to rejection.
A score above 65 blocks auto-submission and creates an itemized remediation checklist, showing the billing team what to correct before submission.
- Insurer-specific rejection checks
- 0-100 risk score per claim
- Itemized remediation checklist
- Auto-submission blocked above 65
Module 3
Revenue Bridge Financing
Claims pending >14 days automatically qualify. Care.Fi can advance up to 80% of the claim's face value within 48 hours of qualification.
The financing is structured as a receivables assignment. When the insurer settles the claim, payment goes first to Care.Fi to recover the advance. The remaining balance goes to the hospital. Settlement is the repayment event.
Growth includes the financing module by default. Starter hospitals can add it as an optional upgrade.
- Auto-qualify when pending >14 days
- Up to 80% of claim face value advanced
- 48-hour fund transfer after qualification
- Repayment tied to insurer settlement
Works with your existing stack
Connect Care.Fi to your hospital systems, TPA portals, insurer APIs, and banking infrastructure.
HIS Connectors
HL7 v2, FHIR R4, and proprietary export formats from major Indian HIS vendors.
TPA Portals
API integration with Medi-Assist, Paramount, and MDIndia.
Insurer APIs
Connections to Star Health, HDFC Ergo, ICICI Lombard, and national insurers.
Banking Partners
NEFT and IMPS disbursement through registered NBFC banking infrastructure.
Built for health data compliance
Care.Fi is designed for hospitals operating under NABH accreditation and IRDAI regulations, with protections for claim data and financial records.
Data encryption and access
Claim data is encrypted in transit and at rest. Role-based access controls help each staff member see the records needed for their function.
Audit trail and logging
Every claim action is logged with a timestamp and user ID. Teams can review the full audit trail from ingestion through settlement.