Runtime infrastructure · TPA claims
Every claim. Every workflow. One runtime.
Indian TPAs run on document chaos, manual review queues, and email queries. Slate Labs is the operating system layer underneath. AI agents read, reason, and route every claim through pre-auth, enhancement, discharge, and FWA, while your reviewers own every decision.
The TPA reality
A typical TPA processes thousands of pre-auth requests, enhancements, and discharges every day. Most of that work is still manual: opening documents, reading discharge summaries, comparing line items against policy terms, drafting queries, chasing missing paperwork. We hand the repetitive, rules-heavy reasoning to specialised AI agents so your humans focus on the judgement calls only they should make.
Pre-auth forms, ICPs, bills, prescriptions, investigation reports, and discharge summaries arrive in inconsistent formats from hundreds of hospitals. No two packets look the same. Reviewers spend 40% of their day just locating the right file.
Manual review queues stretch turnaround time for hospitals and members, trigger SLA breaches with insurer clients, and compound during peak claim periods when volumes spike without warning.
The same missing-document and clarification queries get drafted from scratch, claim after claim, day after day. Every query that goes out without a cited reason invites a back-and-forth that delays the entire packet.
Decisions scatter across emails, portals, and PDFs. Reconstructing why a claim was approved, queried, or denied takes hours, and in dispute or audit scenarios, those hours become days.
Runtime processes
The Claims OS runs six AI agent teams, each owning a defined stage of the claims lifecycle. They don't help your team. They run the workflow. Your reviewers are the control plane.
Reads pre-auth forms, ICPs, bills, prescriptions, investigations, discharge summaries, and policies. Classifies, extracts, and links clinical, billing, and policy entities into a structured claim record.
Tools: OCR · document classifier · entity linker
Checks completeness, summarizes diagnosis and planned treatment, validates eligibility against policy terms, and prepares a one-screen reviewer packet with citations to source pages.
Tools: policy retriever · clinical summarizer · eligibility checker
Reconciles final bills, discharge summaries, package rules, and policy terms. Surfaces non-payable items, duplicates, and ineligible charges with the supporting clause cited.
Tools: tariff matcher · clause linker · bill reconciler
Drafts structured queries to hospitals, members, or internal teams with evidence and missing-document context attached. Reviewer reviews and sends, never starts from a blank screen.
Tools: template library · evidence assembler · channel router
Detects duplicate claims, suspicious billing patterns, unusual provider behaviour, and policy inconsistencies. Hands investigators a packet with the supporting evidence already pulled together.
Tools: similarity index · provider profiler · pattern miner
Shapes structured, interoperable claim data from messy documents to support NHCX-aligned exchange with insurer and hospital partners. FHIR-shaped where it matters.
Tools: FHIR mapper · schema validator · insurer adapters
How we build
Each TPA workflow runs a coordinated team of AI agents with defined inputs, defined tools, and a defined output. There are no black boxes. If an AI agent cannot cite its source, the output does not ship.
Hard-coded rules engines break on the edge cases that make up a third of every claims queue. Our AI agents combine retrieval, structured reasoning, and policy grounding to handle the claims that rules cannot.
AI agents prepare, structure, and recommend. Your licensed reviewers approve. Every action the OS takes is logged, auditable, and reversible. We do not want to replace your reviewers. We want to make each one do the work of three.
Pilot
We run the Claims OS against your historical claims, 500 to 5,000 files. Your reviewers work the dashboard. After 6 weeks you have measured outcomes, not a slide deck.
Read the pilot brief →