Everything you need to know about ClearCycle

ClearCycle is an AI-powered revenue cycle management platform built specifically for Indian private hospitals. It automates the full insurance claim lifecycle — from ICD-10 coding of discharge summaries to TPA submission, policy adjudication, and appeal letter generation — so hospitals can recover 85–90% of billable revenue on first pass.

Most hospitals go fully live within 2 weeks. Week 1 covers API integration with your existing HIS/EMR and configuring the 3-gate approval workflow. Week 2 covers TPA portal connections and staff training. We handle the integration work — your team just needs to approve configurations.

No. ClearCycle integrates alongside your existing Hospital Information System (HIS) or EMR via API. It ingests discharge summary data from your system, enriches it with AI coding and adjudication, and pushes claims to TPA portals. Your existing workflows stay intact.

Yes. We offer a 3-month free pilot to the first hospitals we onboard. You get the full platform — AI coding, TPA submission, payer intelligence, and appeal generation — with no commitment. ROI is typically visible within the first 30 days.

ClearCycle's coding engine achieves 92–95% accuracy on ICD-10-CM and CPT coding for common admission types. It also runs CCI (Correct Coding Initiative) edit checks and MUE (Medically Unlikely Edits) validation before submission, reducing denials caused by coding errors by up to 60%.

ClearCycle supports ICD-10-CM (diagnosis), ICD-10-PCS (procedures), CPT codes, and NABH-aligned coding conventions used by major Indian TPAs. It generates FHIR R4-compliant claim bundles for NHCX submission.

Only claims with a confidence score below your configured threshold (default 85%) require doctor review. High-confidence claims move through the 3-gate workflow — doctor approves via SMS OTP, billing confirms financials, admin gives final sign-off — in minutes rather than days.

ClearCycle currently has built-in payer profiles and submission connectors for Star Health, ICICI Lombard, United Health Insurance, HDFC Ergo, and New India Assurance. We hold 42 behavioural profiles across these TPAs covering known rejection patterns, room upgrade deduction rules, implant invoice requirements, and more.

Payer intelligence is ClearCycle's database of TPA-specific rejection patterns learned from thousands of claims. For example, it knows that Star Health rejects 34% of ortho claims without an implant invoice attached, and that ICICI Lombard systematically deducts room upgrade charges above a threshold. Before submission, ClearCycle flags claims that match these patterns and prompts for the missing documentation.

ClearCycle automatically generates an IRDAI-compliant appeal letter citing the denial reason, clinical evidence from the discharge summary, and relevant policy terms — in under 60 seconds. The appeal is queued for admin review and resubmission. Most resubmissions are resolved within 7–14 days vs the industry average of 45–90 days.

Yes. ClearCycle maintains a 7-year audit trail per IRDAI guidelines, generates IRDAI-compliant appeal letters, and supports NHCX-ready FHIR R4 claim bundle generation. All doctor approvals are captured via OTP and stored as medicolegally defensible records.

Every data processing operation in ClearCycle has a documented legal basis under DPDP Act 2023 (primarily consent and legitimate interest for billing). Patient data never leaves India — all infrastructure runs on AWS ap-south-1 (Mumbai). Data is encrypted in transit (TLS 1.3) and at rest (AES-256). We provide a standard DPA (Data Processing Agreement) for hospital sign-off.

Yes. ClearCycle generates FHIR R4 claim bundles compatible with the National Health Claims Exchange (NHCX) specification. We are monitoring IRDAI's NHCX rollout timeline and will update our connector as the mandatory adoption schedule is confirmed.

ClearCycle is priced as a monthly SaaS subscription based on claim volume (number of cashless/reimbursement claims processed per month). Pricing starts at ₹2 lakhs per month for hospitals processing up to 200 claims/month. Contact us for a custom quote — the 3-month pilot is completely free.

A hospital billing ₹2 crore per month typically recovers ₹20–36 lakhs in additional revenue per month after implementing ClearCycle — through improved first-pass acceptance rates (65–70% → 85–90%), faster appeal resolution, and eliminated manual TPA portal work. The platform pays for itself in the first month.

Most hospitals see measurable improvement in first-pass acceptance rates within the first 2–4 weeks of go-live. Full ROI impact is typically visible after 60–90 days as the payer intelligence engine accumulates claim data specific to your hospital's payer mix.