Industry challenges
File volume
Thousands of claims and reimbursement requests to process daily across provincial health plans.
Prescription consistency
Do the billed medications match the physician's prescription?
Insurance coverage
Verify patient entitlements under provincial health insurance and supplemental plans before each procedure.
Document fraud
Detection of falsified prescriptions and billing inconsistencies.
Documents processed
- —Medical prescriptions
- —Claims forms (OHIP, RAMQ, MSP, etc.)
- —Provincial health cards and insurance policies
- —Hospital invoices
- —Pre-authorisations
- —Medical reports
- —Admission forms
- —Extended health benefit certificates
Automatic validations
- ✓Billed medications = prescribed medications
- ✓Prescribing physician registered with provincial college of physicians
- ✓Patient entitlements verified at date of care
- ✓Billed amount compliant with provincial fee schedule
- ✓Date consistency between prescription and care
- ✓Patient identity verified across all documents
Measured results
85%
time saved
+25%
fraud detected
-45%
reimbursement delay