Built for hospital administrators and billing teams
Help your hospital prevent health insurance claim denials before filing.
Pramaan reads policy and claim documents, flags denial risk, and tells your team what to fix, file, or hold.
| Claim | Payer | Amount | Win | Status |
|---|---|---|---|---|
CLM-4821 Waiting period check | Insurer A | ₹2.4L | 0% | Hold |
CLM-4819 Exclusion review | Insurer B | ₹95K | 0% | Review |
CLM-4814 Documentation gap | Insurer C | ₹1.1L | 0% | Risk |
health claims repudiated in FY25, after the insurer reviewed them
the reported value of those denials in FY25, up from ₹21,861 Cr in FY23
the insurer's deadline to settle or reject after the last necessary document, or pay interest
Claim counts from the IRDAI Annual Report 2024-25. Settlement timeline from IRDAI (Health Insurance) Regulations, 2016, regulation 27.
From documents to a defensible claim.
Upload. Parse the fine print. Structure the claim. Get a straight report. The same Pramaan pipeline that powers pre-file decisions for your billing team.
Documents to report
Waiting period served · exclusion misapplied · prior rulings attached
The fine print is the case
We read every clause against IRDAI rules and past Ombudsman rulings, not a checklist.
Honesty before the fight
If you don't have a case, we say so. A rejection isn't automatically worth an appeal.
Appeal support after the report
Pramaan drafts the grievance path and recommended language. Your team reviews and follows up with the insurer. Sending stays human-led.
How it works
Pramaan is decision support. It recommends file, fix, or hold, and drafts appeal grounds when a denial should not stand. Your billing team reviews and sends the follow-up. We do not auto-file with insurers.
See risk in the queue
Every claim ranked by denial likelihood and financial impact, so billing focuses on what matters first.
Pramaan reads the case
Policy clauses, IRDAI rules, and Ombudsman patterns against the documents you already have, before submission.
Decide: file, fix, or hold
A straight recommendation with grounds. Fix weak docs, hold a claim that will be denied, or file with confidence.
Learn from every appeal
Appeal outcomes feed back into pre-file flags, so the next denial is cheaper than the last.
Decision support from the appeal side of the table.
Claims software sees the denial and stops. Appeal support is where we start, and we bring that signal back to filing.
Intelligent denial prioritization
Rank claims by overturn likelihood and rupees at risk, not first-in, first-out.
Policy-aware decisions
Pramaan checks clauses, waiting periods, and exclusions against IRDAI and Ombudsman precedent.
Pre-file rejection flags
Know what will be denied before you submit. Fix the packet or hold the claim.
Appeal-trained intelligence
Every appeal we support teaches the next pre-file flag. Claims software never sees that side.
Share a small set of past rejected or pending claims.
We identify recurring denial patterns and show where Pramaan could have helped. Administrators and billing teams run the work. CFOs see the rupees at risk.
See Pramaan on your own claims
Administrators and billing teams run the review. Your CFO can join to see the rupees at risk.