AI for Medical Claim Automation & Fraud Detection

Sherlock platform helps process nearly five million claims annually for our global customers. Claims are passed through our AI/ML algorithms, medical necessity rules, medical adjudication & automation algorithms, NLP based auto ICD coding methods and digitization of paper claims.

Sherlock platform has helped our global insurance customers have save over US$ 100 million through controlling claims leakages, automation and efficiency gains.

Our customers have established over 99% accuracy of Sherlock platform's decision to pay a claim through the means of independent A/B tests and manual audits.

Reducing false positives in cases of a claim deny decision has been a hallmark of the Sherlock platform. The hit rate for our claim deny decisions has been over 80% helping our customers save several millions of dollars every year.

Easy integration and deployment for the Sherlock platform has allowed our global insurance customers to realize high RoI within three months of usage.

Sherlock has one of the world's most comprehensive medical payment integrity engine that uses intelligence of over one million medical payment integrity scenarios and rules before approving each claim.