Transform Health Claims into Instant, Audit-Ready Decisions.
The two-sided automated claims layer for Nepali insurers and patients. Zero manual photo triage—instant OCR extraction runs the moment patients upload, handing off pre-validated ledgers directly to insurer adjudication desks.
One Engine. Tailored Direct Gateways.
Whether you are a policyholder submitting raw hospital bills or an insurance claims officer managing compliance queues, InsureHelp gives you dedicated workflows.
For Patients & Policyholders
Take control of your medical reimbursement without bureaucratic delays or confusing tariff deductions.
- Upload bills & discharge summaries directly: Supports multi-page phone photos, PDFs, and laboratory slips.
- Real-time OCR extraction in <1 sec: High-precision text parsing runs before insurer handoff to guarantee completeness.
- Live 5-stage claim status & transparent reason trace: Know exactly why an item was approved or flagged instantly.
For Insurers, TPAs & Adjudicators
Streamline claims operations, eliminate manual bill line audit, and maintain full compliance with Nepal Insurance Authority guidelines.
- Upload Policyholder Registry (CSV): Instant automated matching of active policy terms, limits, and deductible conditions.
- Review pre-validated structured records: Replace paper stacks with deterministic 42-line ledger audits and item-by-item flags.
- One-click 30-day statutory settlement: Generate structured reason memos, settlement notices, and digital payout authorizations.
Precision Instrumentation for Claims Teams
Empower your adjudication officers and policyholders with deterministic rule engines and transparent AI reasoning traces for every single claim.
Multi-Document Ingestion
Optical ingestion & schema transformation at patient upload. Seamlessly parses discharge summaries, medicine receipts, and itemized bills into validated tabular schemas with zero manual typing.
Deterministic Rule Engine
Sub-limits, daily room rent caps, NIA exclusions, and policy waiting periods applied with zero probabilistic guesswork. Strictly enforces statutory caps with 100% mathematical auditability.
Audit-Ready Reasoning Trace
Eliminates dispute ambiguity with transparent deduction memos. Every adjudication flags unauthorized line items (e.g. vitamins, food items) with specific statutory clause references.
Statutory 30-Day Health Claim Settlement Target
Nepali insurance regulations mandate strict settlement SLAs. InsureHelp condenses the standard 14-day manual bill validation period down to minutes, allowing claims adjusters to issue approvals without regulatory penalties.