Global Claims Intelligence

AI in the claims room.

Toda AI turns multi-day claims backlogs into 24-hour decisions — with fraud detection, ICD-10/11 coding, and full audit trails built in.

80%
Faster turnaround
40%
Lower admin costs
50%
Fraud reduction
The Problem

Health insurers are
drowning in manual work

Across Africa and emerging markets globally, the claims function remains stubbornly manual — slow, expensive, and error-prone.

7–14d
Days per claim
Slow turnaround frustrates providers and delays critical reimbursements globally
20%
Fraudulent claims
Fraudulent submissions account for 10–20% of total claims costs industry-wide
50%
Of operational budget
Labour-intensive workflows consume up to 50% of insurer operational budgets
Higher cost per claim
Manual processing costs 3× more per claim vs AI-automated adjudication
Key Capabilities

The Toda AI
adjudication engine

Real-time adjudication

Process claims as they arrive — up to 1,000 claims every 10 minutes with anomaly detection running simultaneously on every submission.

Advanced fraud detection

Longitudinal pattern recognition identifies fraudulent claims with 30–50% fraud reduction, protecting insurer revenues at global scale.

OCR document reading

Automated extraction from scanned and handwritten claim documents. Eliminate manual data entry from paper-based submissions entirely.

ICD-10 / ICD-11 standardization

Every claim validated and mapped to global coding standards — enabling compliance with international health insurance regulations and cross-border reporting.

System integration

Full sync with existing insurer platforms and hospital information systems. No rip-and-replace required — Toda AI layers on top of current infrastructure.

Transparent audit trail

Every adjudication decision is traceable and justified. Build provider trust and satisfy regulatory requirements with complete transparency.

How It Works

The adjudication workflow

01

Claim submission & OCR extraction

Claims arrive via API, upload, or direct integration. OCR automatically extracts structured data from paper-based or scanned submissions, eliminating manual entry.

02

AI pre-screening & fraud detection

Each claim is scored against longitudinal fraud patterns, provider benchmarks, and policy rules. Suspicious claims are flagged for human review before proceeding.

03

ICD-10/11 mapping & policy validation

Diagnoses are mapped to global coding standards. The system validates benefit entitlements, coverage limits, and pre-authorization requirements automatically.

04

Adjudication decision

Clean claims are approved, queried, or rejected with full justification codes — all within the defined processing window. Human adjudicators review only flagged edge cases.

05

Payment processing & provider notification

Approved claims feed into the payment workflow. Providers receive real-time status updates with itemized adjudication decisions.

Pricing

Choose your
adjudication scale

All plans include core adjudication, OCR, and system integration.

Starter
Base
100 Claims / 10 Minutes
  • Pre-configured industry rules
  • Standard sensitivity
  • OCR auto-reading
  • Editable rule scope
  • Longitudinal fraud detection
Most Popular
Growth
Advanced
1,000 Claims / 10 Minutes
  • Editable scope, global application
  • Adjustable sensitivity
  • OCR auto-reading
  • Multi-batch simultaneous
  • Advanced fraud detection
Enterprise
Enterprise
1,000+ Claims / 10 Minutes
  • Fully editable across all facilities
  • Adaptive AI-tuned sensitivity
  • Longitudinal fraud patterns
  • Per-facility AI calibration
  • Dedicated account manager

Turn backlogs into
24-hour decisions.

See Toda AI process your claims in a live demonstration.