The enterprise platform to process claims in minutes, not days.
ClaimGPT unifies review, ICD/CPT coding, rejection-risk scoring, fraud triage and IRDAI submission so TPAs and insurers cut turnaround, raise accuracy, and scale operations with confidence.
Microsoft Partner · deploys on Azure · self-hosted LLM · zero PHI egress · ISO 27001 · HIPAA-aligned
Manual claims processing is slow, costly, and leaky.
Reviewers retype 20+ fields per claim from scanned PDFs — hours of effort.
Wrong ICD/CPT drives rejections, rework and lost revenue.
Over-billing escapes manual checks with no early signal.
Hand-filled forms bounce; no audit trail; PHI sent to external AI.
From upload to submission in four steps.
A single intelligent layer connects fragmented workflows — less manual effort, better accuracy, faster claims across the lifecycle.
Drop PDFs, scans, Word, Excel. Auto-dedupe and patient matching.
Extract, code, score and validate — automatically.
Fix fields inline and ask questions in plain language.
Submission-ready IRDAI forms and payer files.
Visibility across queues, stages and adjudication status.
“Where claims operations, validation, and decisioning come together — days of manual work compressed into minutes.”
Engineered by WaferWire Cloud Technologies.
WaferWire (WCT) is a global cloud, data and AI engineering company and a Microsoft partner, trusted by enterprises across healthcare, finance and the public sector. With delivery teams in the US and India, we design, build and run secure, large-scale software on Azure — ClaimGPT is our healthcare claims platform, built to self-host so protected data never leaves your environment.
Cloud-native apps and applied AI delivered on Microsoft Azure for regulated enterprises.
IRDAI · ISO 27001 · DPDP · HIPAA-aligned with append-only audit trails.
Engineering across Redmond and Hyderabad; deployable in any Azure region.
Enterprise cloud, data and AI delivery.
For startups to Fortune 500 enterprises.
Redmond, USA · Hyderabad, India.
Risk models, NER coding, fraud analytics.
What ClaimGPT does for every claim.
Drop in a stack of documents and ClaimGPT turns them into a decision-ready claim — extracted, coded, scored, validated and submission-ready — with a human reviewer always in control.
Reads scanned PDFs, photos and forms, detects document types, de-duplicates pages and links them to the right patient — then pulls 20+ fields like diagnosis, dates, policy and expenses automatically.
Assigns ICD-10 diagnosis and CPT procedure codes with confidence scores across 500+ ICD / 180+ CPT, with cost estimation — so coding is consistent, not guesswork.
Predicts rejection risk in under 120ms with the top contributing factors, and flags fraud as LOW / MEDIUM / HIGH before a reviewer ever opens the file.
Runs 11 deterministic rules, generates fillable IRDAI forms and TPA reports, and sends FHIR / X12 to the payer — with a full audit trail at every step.
- ✓ Conversational Q&A on any claim — ask “why is this high risk?”
- ✓ Inline field correction with before/after diff
- ✓ Cross-document search to surface precedents
- ✓ Reimbursement & cashless flows, INR-ready
A capability for every stage of the claim.
Eleven specialized services work together behind one workspace — so reviewers get a complete, decision-ready picture without switching tools.
Tesseract + OpenCV read every page; medical scans (MRI, CT, X-Ray, PET) auto-detected and classified.
LayoutLMv3 + 40 patterns pull 20+ fields — patient, policy, diagnosis, admission dates, expenses.
scispaCy NER maps 500+ ICD-10 and 180+ CPT codes with confidence and cost estimates.
XGBoost + LightGBM score risk in <120ms with the top-5 contributing factors explained.
10 deterministic rules + ML anomaly + optional LLM flag LOW / MEDIUM / HIGH risk.
Fillable IRDAI claim forms (70+ fields), TPA reports, FHIR R4 and X12 837P to payers.
Protecting sensitive patient information by design.
Healthcare claims carry the most sensitive data there is. ClaimGPT keeps it protected end-to-end — patient information stays inside your environment, scrubbed before any AI ever sees it, with every action logged.
SSN, phone, email, MRN, DOB and policy numbers are stripped before any model call.
Run on-prem or in your cloud — zero PHI egress to external APIs.
Granular RBAC so reviewers, coders and approvers see only what they should.
Every view, edit and decision is recorded for HIPAA-grade traceability.
IRDAI · ISO 27001 · DPDP · HIPAA-aligned workflows.
Deployable in your own region with isolated, encrypted storage.
Frequently asked questions.
What is AI-powered claims processing?
It uses AI, OCR, ML and automation to extract, validate, review and process medical claims faster and more accurately than manual workflows.
How does ClaimGPT help TPAs?
It automates review, ICD coding, validation, fraud checks and risk scoring to cut turnaround and workload.
Can it integrate with existing systems?
Yes — integrates via FHIR R4 and X12 837P without full platform replacement.
Does it support IRDAI compliance?
Yes — configurable validation, audit-ready processing, and fillable IRDAI Standard Reimbursement Claim Forms.
Is patient data sent to external AI?
No. A self-hosted LLM with PHI scrubbing keeps protected data in your environment.
Outcomes claims teams see with ClaimGPT.
Auto-extraction and coding remove hours of re-keying per claim.
11 rules and risk scoring clear clean claims in seconds.
Every action logged for HIPAA-grade traceability.
Get started with ClaimGPT.
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Reduce bottlenecks, improve accuracy, and accelerate decisions with AI-assisted claims workflows.
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