The Med Lighthouse AI Insurance Engine uses machine learning to evaluate the probability of insurance claim approval or rejection before the claim is ever submitted — protecting your facility's revenue at the source.
By analysing the alignment between patient complaint, diagnosis, requested procedures, and each insurer's policy coverage rules, it gives clinicians and billing teams actionable intelligence — in real time — at the point of care.
Three steps that protect your revenue before a single claim leaves your facility.
As the physician records the patient's complaint, diagnosis (ICD-10/11), and orders investigations or procedures (CPT codes), the AI engine reads this data in real time from the EMR workflow.
The engine cross-references the clinical data against the patient's specific insurance plan — checking coverage rules, pre-authorisation requirements, and historical rejection patterns for that insurer.
A real-time acceptance probability score is displayed — along with specific guidance on what adjustments (documentation, coding, or procedure selection) would improve the claim's chance of approval.
Claim rejections and partial approvals represent a significant portion of a facility's annual revenue loss. The AI engine reduces this leakage by catching misalignment before submission.
Cleaner claims mean faster approval and shorter settlement turnaround times — improving your facility's cash flow and reducing the administrative burden of resubmissions.
Physicians receive guidance at the point of care — not after rejection. This enables better-documented encounters that support both clinical quality and billing accuracy simultaneously.
The HIS insurance dashboard tracks rejection reasons, insurer-level performance, recovery rates, and settlement TAT — giving managers the data to identify patterns and intervene proactively.
Talk to our team in Doha and see how the AI Insurance Engine can be integrated into your existing billing and clinical workflow.
Book a Free Demo