NIVA's AI chatbot for healthcare automates claim status queries, pre-authorization guidance, document checklists, adjudication support, and fraud triage · reducing manual touchpoints by up to 70%.
From the moment a member submits a claim to final settlement · NIVA's medical claims chatbot keeps every interaction instant, accurate, and compliant.
Members and providers get instant claim status updates · submitted, under review, pending documents, approved, or rejected · without calling the TPA helpline. NIVA pulls live data from your claims system via webhook.
NIVA walks members and hospital staff through pre-auth eligibility, required documents, and turnaround times for planned procedures. Auto-triggers the pre-auth workflow and sends confirmation to both the member and provider.
Reduce incomplete claim submissions by 60%. NIVA provides procedure-specific document checklists, validates what's been received, flags missing items, and sends upload links directly to members · all without agent involvement.
Members instantly verify if a hospital, specialist, or diagnostic centre is in their policy network before treatment. NIVA cross-references your empanelled provider database and shows cashless facility eligibility in real time.
NIVA flags suspicious claim patterns for adjuster review · duplicate submissions, upcoding alerts, unusually high procedure frequencies, and ICD-CPT mismatches. Reduces leakage before manual review begins.
Members no longer need to call to understand why a claim was partially paid. NIVA explains deductibles, co-pay calculations, sub-limits, exclusions, and non-payable items in plain language · reducing dispute escalations by up to 50%.
NIVA's claims AI doesn't just answer questions · it actively participates in adjudication workflows, clinical triage, and compliance checks.
For planned hospitalizations, NIVA orchestrates the entire cashless journey: member eligibility → hospital pre-auth request → insurer approval → discharge documentation → final bill reconciliation. Connects to your TPA portal via API.
NIVA acts as a co-pilot for claims adjusters · surfacing relevant policy clauses, ICD-10 code definitions, CPT benchmarks, and comparable approved/rejected claim history from your knowledge base before the adjuster makes a decision.
For employers managing group health policies, NIVA becomes the 24/7 HR helpdesk · answering employee benefit questions, coordinating dependant additions, tracking corporate float utilization, and generating monthly claims dashboards via chat.
NIVA handles Ayushman Bharat (PMJAY), CGHS, ESI, and state-scheme beneficiary queries · eligibility verification, empanelled hospital lookups, package rate checks, and entitlement balance queries · in 10+ regional languages.
Every persona ships pre-trained with healthcare domain knowledge, ICD-10/CPT terminology, TPA workflows, and insurance policy language. Subscribe to the ones your operation needs · no prompt engineering.
From persona selection to a live bot on your member portal or TPA website in under a week. NIVA handles all AI infrastructure · you configure what matters.
Choose the Medical Claims vertical from NIVA's domain library. The system auto-loads ICD-10/CPT context, TPA workflow terminology, and healthcare-specific conversation patterns.
Pick from 10+ pre-built claims personas. Toggle on Member Support, Pre-Auth Coordinator, Fraud Triage Advisor · whichever roles your operation needs. Customise tone and brand in minutes.
Add policy wordings, tariff schedules, empanelled provider lists, exclusion annexures, and SOPs as PDFs or URLs. NIVA indexes them into a private vector database · your bot answers exactly what you teach it.
Drop a single line of HTML on your member portal, TPA website, or hospital partner page. The bot goes live fully branded. Update knowledge or swap personas instantly · no redeployment.
Upload policy documents, tariff schedules, clinical coding guides, and SOPs. NIVA's RAG engine retrieves the most relevant clause and cites it in every answer · no hallucination, no generic responses.
NIVA remembers returning members by policy number, claim history, and past interactions. No re-explaining the situation · the bot picks up exactly where the last conversation ended, even across channels.
Build claims workflows in NIVA's no-code Flow Engine: document received → trigger validation → notify member → webhook to claims system → update status. Fully automated, fully auditable.
NIVA understands clinical coding natively. Upload your tariff schedules, NABH package rates, or IRDAI standard rates · the bot validates code-procedure-diagnosis alignment and flags mismatches before adjudication.
NIVA connects to your claims management system · HealthEdge, Sapphire, or custom-built · via webhook. Members and adjusters query live claim data, approval status, and payment details without screen-switching.
Serve beneficiaries across India in Hindi, Tamil, Telugu, Kannada, Bengali, Marathi, and 10+ other languages. NIVA auto-detects language and responds accordingly · critical for government scheme beneficiaries.
Book a 30-minute demo and see NIVA's claims personas in action · handling real member queries, pre-auth workflows, and adjudication lookups live on your data.