The compliance layer connecting MENA healthcare.
ClaimRidge brings providers, doctors, and insurers together across pre-authorisation and claims. Our AI validates medical necessity and payer rules instantly, meaning fewer denials for providers and automated adjudication for insurers.
One platform, three perspectives.
Providers
Hospitals and clinics manage their clinical staff, oversee billing compliance, and review AI suggestions to ensure claims are clean before submission.
Doctors
Clinicians request pre-authorisations with full visibility, getting faster approvals for planned procedures with medical necessity verified instantly.
Insurers
Payer medical teams review pre-auths and claims automatically scored for fraud risk and policy compliance, saving countless hours of manual adjudication.
The full lifecycle of care.
From the moment care is planned to the final payment, ClaimRidge connects the dots.
Pre-authorisation
Before care happens, providers request a greenlight. Insurers review medical necessity against their policy. On approval, a time-boxed authorization number is issued, locking in the scope of care.
- Instant payer rules validation
- Digital clinical document attachments
- Faster patient care access
Claims Processing
After care, providers file the bill. If an authorization number exists, it's instantly linked and verified. The AI scrubs for coding compliance, and the insurer adjudicates the final submission.
- Automated CPT & ICD-10 scrubbing
- Upcoding & bundling detection
- Seamless pre-auth linkage
Review before you send.
Catch coding and billing errors internally. Nothing is submitted to the insurer until you confirm it's correct.
Extract & Submit
Drop in clinical documents. The AI auto-fills the form fields with per-field confidence scores.
Review AI Suggestions
The AI scrubs the claim against payer policy. Review its compliance suggestions and fix any issues before it leaves your system.
Confirm & Adjudicate
Confirm and send. The clean claim reaches the insurer, where it is automatically scored and adjudicated for a rapid verdict.
Platform Capabilities
AI Claim Scrubbing
Checks coding & billing compliance (CPT ↔ ICD-10, NCCI, modifiers, fee schedules) against specific payer rules.
Statistical Fraud Detection
An advanced ML model scores claims for fraud risk on the insurer side to flag suspicious billing patterns.
Automated Adjudication
Produces accept, deny, or escalate verdicts by combining the coding review, fraud score, and payer policy.
Authorization Linkage
Automatically verifies claims against pre-auth validity windows, patient identity, and approved procedures.
AI Assistant
A read-only assistant in every portal answering questions about claims, pre-auths, and policy with cited sources.
Audit Trail & Compliance
An append-only, hash-chained event log with PII-access logging and data retention tooling for full accountability.
Built for MENA Healthcare
The compliance layer aligned with regional standards, trained on payer rules across Jordan, UAE, Saudi Arabia, and the GCC.
End-to-end Encryption
Data is encrypted in transit and at rest using industry-standard protocols.
PDPL Alignment
Designed with data-protection requirements in mind, including retention and erasure tooling.
Immutable Audit Trail
Hash-chained event logging ensures every action and PII access is recorded permanently.
Connect the dots in your healthcare workflow.
Whether you're a hospital reducing rejections, a doctor speeding up care, or an insurer automating reviews — ClaimRidge brings compliance from day one.