MediClaim AI - Automated Authorization Workflow
MediClaim AI is an end-to-end automated prior authorization workflow built using AppliedAI’s Opus platform. The system accepts multiple input formats PDFs, images, CSVs, structured text and normalizes them through intelligent preprocessing. Using OCR, clinical data extraction agents, deterministic rule evaluation, enrichment via mock EHR/policy services, and a composite scoring engine, the workflow generates clear approval decisions or routes complex cases for agentic or human review. Each case produces a complete audit artifact and multi-channel delivery (email, Sheets, webhook). This solution reduces administrative delays, eliminates repetitive manual work, improves documentation quality, and accelerates decision turnaround for healthcare providers and insurers.
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