Stop Fraud
Before It's Paid
ClaimGuard is a white-labeled, end-to-end platform connecting your scheme to every hospital you work with — branded claim submission, real-time AI fraud scoring, and reviewer tools in one place, built on the OpenIMIS you already run.
See It In Action
Trusted by leading insurance schemes to run a single branded platform across hundreds of hospitals and millions in payouts.
One Platform for Your Whole Network
From hospital submission to AI-scored review — ClaimGuard connects your scheme and every facility you work with in a single branded experience.
White-Label Branding
Your logo, your name — the hospital portal and reviewer console carry your scheme's own identity end to end.
Hospital Submission Portal
Every hospital in your network submits claims through its own branded portal, straight into your OpenIMIS instance.
Cross-Facility Patterns
The same patient claiming treatment at multiple hospitals in a short window — visible only with scheme-wide data.
Real-Time AI Scoring
Every claim scored the moment it lands, against amount anomalies, duplicates, and provider outliers — with plain-language reasoning.
Built on OpenIMIS
Installs as a standard OpenIMIS module via the documented signal pipeline. No rip-and-replace, no parallel system.
Human-in-the-Loop Review
The AI suggests a next step; your reviewers stay in control and act directly in OpenIMIS.
How it works
One connected flow from hospital to scheme — branded for you, built on the OpenIMIS you already run.
Hospital submits
Facility staff sign in to your branded portal and submit a claim — no workflow change on their end.
Syncs to OpenIMIS
The claim lands in your OpenIMIS instance exactly as it would today.
AI scores in real time
ClaimGuard scores it against six fraud families and scheme-wide patterns the moment it arrives.
Reviewer gets a recommendation
A plain-language suggestion — approve, investigate, or reject — for your reviewer to act on directly in OpenIMIS.
Why Choose ClaimGuard
One white-labeled platform connecting your scheme to every hospital you work with — built directly into the OpenIMIS infrastructure you already run.
Cross-Hospital Visibility
Detect patient and provider patterns no individual hospital can see — the signal lives in the scheme, not the facility.
One Branded Platform
White-labeled for your scheme, from the hospital submission portal to the reviewer console — installed directly into the OpenIMIS you already run.
Common questions
OpenIMIS catches exact duplicates. ClaimGuard catches statistical anomalies, near-duplicates, cross-facility patterns, service–diagnosis mismatches, and provider outliers — patterns that pass the existing checks.
No. ClaimGuard never writes back to a claim. The AI scores it and suggests approve, investigate, or reject — your reviewer acts on that recommendation directly in OpenIMIS.
No. ClaimGuard installs as a standard OpenIMIS backend module via openimis.json. It listens to the documented claim submission signal — no fork, no core changes.
Both. Hospitals in your network sign in to their own branded portal to submit claims; your scheme's reviewers see the same claims, scored, in your branded console — one platform, two sides.
We tune precision per scheme and surface reasoning with every flag, so reviewers can dismiss false positives in seconds. The system learns from your decisions.
Inside your scheme's environment. ClaimGuard runs against your OpenIMIS database; only de-identified signals leave your perimeter when you opt into benchmarking.
Ready to connect your network?
Book a 30-minute walkthrough on real claim data — from hospital submission to AI-scored review, branded as your own.