Your billing team is losing crores to a broken claims process.

ClearCycle automates the entire claim lifecycle — from discharge summary to TPA settlement. ML payer intelligence scores every line for deduction risk before you submit.

Contact Sales See How It Works

THE PROBLEM

Manual billing is costing your hospital more than you think.

₹8,000 Crore Lost Every Year

Indian private hospitals lose 15–25% of billable revenue to claim denials and underpayments — often for avoidable coding and documentation errors.

45–90 Days to Settlement

Cash flow paralysis. Billing staff spend more time chasing TPAs than serving patients, with no visibility into where claims stand.

Submitting Blind

No awareness that Star Health rejects 34% of ortho claims without an implant invoice, or that ICICI Lombard systematically deducts room upgrade charges.

3–5 Hours Per Appeal

Every denial requires manual research, letter drafting, and resubmission. Most small hospitals have no dedicated RCM team to handle this at scale.

THE SOLUTION

One platform. The entire claim lifecycle.

AI Medical Coding

Reads discharge summaries and assigns ICD-10 and CPT codes with confidence scores, CCI edit validation, and MUE checks.

Policy Adjudication

Evaluates coding against TPA rule sets. Calculates exact insurer payment and patient liability before discharge.

ML Payer Intelligence

Per-line deduction probability scoring before you submit. LightGBM model trained on carrier rejection history. Flags high-risk lines with the exact reason and suggested fix.

3-Gate Approval Workflow

Doctor approves via SMS OTP. Billing reviews financials. Admin gives final sign-off. All digital, all auditable.

Autonomous TPA Submission

Submits to TPA portal automatically after approval. Status tracked daily. Denial triggers appeal letter instantly.

Appeal Letter Generation

IRDAI-compliant appeal letter in 60 seconds. Cites denial reason, clinical evidence, and policy terms.

ML PAYER INTELLIGENCE

Know your deduction risk before you hit submit.

Our LightGBM model learns carrier-specific rejection patterns from your hospital's own remittance history. Every claim line gets a deduction probability score, a predicted amount, and a suggested action — before you submit to the TPA.

Pre-Submission Risk Score

Each procedure line gets a deduction probability (0–100%) and risk tier — High, Medium, or Low — based on your payer's historical behaviour on that CPT/ICD combination.

Expected Deduction Forecast

Know the rupee impact before settlement. Per-line expected deduction and total collection rate help your billing team prioritise which claims to review before submission.

Gets Smarter Over Time

The model fine-tunes on your hospital's actual remittance data — so predictions improve as your claim history grows. Carrier profiles cover Star Health, ICICI Lombard, SBI General, Bajaj Allianz, Tata AIG, and Medi Assist.

How it works: Upload your discharge summary → AI codes the claim → Payer Intelligence scores every line → High-risk lines flagged with exact reason (e.g. "Star Health rejects implant-only CPT without attached invoice") → Billing team corrects before submission → First-pass acceptance rate improves from ~68% to ~88%.

LIVE DEMO

Try it — see deduction risk before you submit

Sample claim: knee arthroplasty · ₹1,21,500 billed

Claim Lines

Procedure	Amount
Total Knee Arthroplasty CPT 27447 · M17.11	₹85,000
Anaesthesia – Major Orthopaedic CPT 00400 · M17.11	₹12,000
Inpatient Room (4 nights) CPT 99232 · M17.11	₹18,000
Post-op Physiotherapy (6 sessions) CPT 97110 · M17.11	₹6,500
Total billed	₹1,21,500

Risk Assessment

Select a payer and click Run Pre-Check

WHY NOW

The Indian health insurance market is at an inflection point.

NHCX Going Mainstream

IRDAI pushing digital claims standardisation. 83 payers and 42,000+ hospitals already onboarded.

Market Growing 15% YoY

More policies, more claims, more complexity. Manual teams cannot scale without automation.

Denial Rates Rising

TPAs tightening rejection criteria year on year. Star Health denial rates up 23% in 2 years.

Margins Under Pressure

Revenue recovery is the fastest path to margin improvement without capital expenditure.

THE IMPACT

What changes at a hospital billing ₹2 crore per month.

Metric	Before	After ClearCycle
Claim processing time	3–5 days	4–6 hours
First-pass TPA acceptance	65–70%	85–90%
Appeal turnaround	3–5 days	Same day
TPA portal work per claim	45–60 minutes	Automated
Revenue recovered monthly	Baseline	+₹20–36 lakhs

₹20–36 lakhs recovered per month vs ₹2–4 lakhs cost. ROI visible within 30 days.

BUILT FOR INDIAN HEALTHCARE

Compliance is not an afterthought.

DPDP Act 2023 — processing basis documented for every data touch

7-year claim audit trail per IRDAI guidelines

ICD-10-CM with CCI edits and MUE validation built in

NHCX-ready FHIR R4 claim bundle generation

AWS ap-south-1 — patient data never leaves India

Doctor OTP sign-off — medicolegally defensible record

Ready to recover what your hospital is owed?

We're offering a 3-month free pilot to the first hospitals we onboard. No commitment. Full pipeline live within 2 weeks.

Contact Sales

+91 91632 36777 · gaurav@gauravhira.dev