Claim Status & Timeline
Members and providers check adjudication status, pending items, and expected completion dates without calling the claims desk.
AI chatbot for Medical Claims
Members, Adjusters, and Providers
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%.
- No usage-based billing
- Live across 25 industries
- White-label ready
ClaimAssist
Medical Claims support · online
Hi! I'm ClaimAssist. I can help with claim status, pre-authorization, document submission, and benefit queries. How can I help you today?
My claim CN-2024-88761 was submitted 12 days ago. What's the status?
Claim CN-2024-88761 is under medical review. Estimated completion: 3 business days. One item pending: a discharge summary from Apollo Hospital. Shall I send you the upload link?
Ask ClaimAssist anything…
Powered by NIVA
- 70%
- Query Deflection
- 24/7
- Member Coverage
- 0
- Code Required
Built forHealth InsurersTPAsClaims AdministratorsEmployer Plans
Every Claims Touchpoint, Deflected Automatically
From status checks to pre-auth and document collection, NIVA handles the high-volume queries that overwhelm claims teams.
Pre-Authorization Requests
Guide pre-auth eligibility, collect clinical codes, and open authorization cases with structured FNOL-style intake.
Document Collection
Send upload links for discharge summaries, invoices, and supporting records, and track what's still missing per claim.
Coverage & Benefit Verification
Answer deductible, co-pay, and procedure coverage questions from plan documents, with clear escalation to human review.
Provider & Network Queries
Help providers confirm network status, fee schedules, and claim submission requirements through chat.
Fraud & Duplicate Triage
Flag duplicate submissions, inconsistent dates, and high-risk patterns for adjuster review before payout.
Questions your visitors ask
Examples from live medical claims deployments, answered in chat instead of routed to inbox.
“Is it safe to take ibuprofen with my blood pressure medication (amlodipine)?”
NSAIDs like ibuprofen can interact with amlodipine and may raise blood pressure. For occasional use, most GPs advise paracetamol as a safer alternative. Please confirm with your GP or pharmacist before taking · shall I book you an appointment?
Why NIVA
Generic bots answer. NIVA acts.
Generic prompts from scratch
250+ industry personas, ready day one
FAQ replies and deflection
Flows, forms, and real actions
Credits, tokens, and add-ons
Flat pricing, full white-label
Teams already using NIVA
Live in 4 steps
From persona setup to live on your member portal in under a day, within your claims compliance boundary.
No-Code Admin
Pick Your Domain
Choose the Medical Claims vertical from NIVA's library with industry terminology built in.
Persona Library
Subscribe to Personas
Pick from 10+ pre-built medical claims personas. Toggle only the roles you need.
Knowledge + Flows
Add Knowledge & Workflows
Upload policies, manuals, and FAQs as PDFs or URLs into a private knowledge base.
One Script Tag
Embed Anywhere
Drop one script tag on your site. The bot goes live fully branded, no redeploy.
Pre-trained Medical Claims personas, ready on day one
Subscribe to expert roles with domain tone and knowledge already built in. Toggle live without prompt engineering.
Claim Status Bot
Status, timeline, pending items
Pre-Auth Coordinator
Eligibility, codes, intake
Document Collection Agent
Uploads, checklists, chase
Benefits Advisor
Coverage, deductibles, co-pay
Provider Support Bot
Network, fees, submission
Fraud Triage Agent
Duplicates, risk scoring
+ 4 more medical claims personas available on your demo
Built for Medical Claims, not generic chatbots
Platform capabilities tuned for medical claims teams. Compliance standards are listed separately below.
Plan & Policy Knowledge Base
Upload plan summaries, clinical policies, and provider manuals. NIVA answers from approved wording only.
Member & Claim Context
Returning members continue with open claim references, pending documents, and prior answers in context.
Pre-Auth & FNOL Flows
Automate intake, document chase, and adjuster handoff sequences with claims-system webhooks.
Claims Platform Integration
Connect to core claims admin, TPA, or policy systems for live status and structured write-back.
Claim Status & Document Chase Flow
Trigger
Member asks status for claim CN-2024-88761
Lookup
Under review, discharge summary pending
Action
Upload link sent, reminder scheduled
Claims
Document received, adjuster notified
Three engines. One medical claims bot.
Workflows, smart forms, and multi-persona routing from a single admin dashboard.
Workflow Automation
Flow Engine
Build multi-step automated workflows inside the chat: conditional branching, dynamic forms, persona handoffs, and webhook triggers.
Learn more Smart FormsSmart Form Engine
Define unlimited forms per bot. The AI reads conversation context and surfaces the right form automatically, inline in the widget.
Learn more Multi-Persona AIAgentic Personas
Run multiple AI agents in one widget. The orchestrator routes each message to the right persona automatically.
Learn moreOne script. Live on your site.
Drop a single line before </body> and your medical claims bot goes live, fully branded as ClaimAssist.
Auto-branded
Your colours, avatar, and bot name in every channel.
Instantly updated
Change personas or flows in admin. No redeploy.
CORS-ready
Website, WhatsApp, and custom domains out of the box.
index.html
<!-- Before </body> -->
<script src="…/widget.js"></script>
✓ Domain: Medical Claims
✓ Bot: ClaimAssist
✓ Personas: subscribed
✓ Status: Live
ComplianceHIPAA AlignedGDPR / PrivacyISO 27001 AlignedPHI Handling Controls
Ready to Deflect 70% of Claims Queries?
Book a demo and see ClaimAssist handle status checks, pre-auth, and document requests live.
Common questions
Quick answers before you book a demo.
Yes. NIVA connects via REST API to surface claim status, pending documents, and write back intake data to your claims system.
Still unsure? Send us your requirements and we will map the right personas for medical claims.
Related use cases
See how NIVA handles specific workflows in your space.
Related industries
Explore NIVA for adjacent verticals.