DocXtract for Healthcare & TPA Claims Automation

Intro

A claim arrives as a bundle: a discharge summary, an itemised hospital bill, prescriptions, diagnostic reports and a pre-authorisation form, each from a hospital with its own formats, abbreviations and handwriting. Adjudication cannot begin until someone has read all of it, and settlement turnaround is measured from the moment that reading starts.

This brief sets out how DocXtract removes the reading step without adding a configuration project per hospital, and what it changes for settlement time and cost per claim.

Key themes include

• The claim bundle, document by document: What has to come off each artefact, and which fields drive adjudication decisions.
• Real-world document condition: Handwritten notes, scanned bundles and photographed submissions read at volume, which is where template-based capture and generic OCR both fail.
• Cross-document validation: Bill against discharge summary, prescription against diagnosis, and claimed amounts against policy limits --- checked before the file reaches an adjudicator.
• Integration into claims platforms: Structured output into TPA and insurer claims systems, with an evidence trail from every field back to its source page.

Outcome

The brief sets out the effect on settlement turnaround, per-claim cost and leakage, with the arithmetic shown so claims leaders can test it against their own book.