End-to-end claim integrity for U.S. health insurers.
ClaimClean supports the full claim review lifecycle — intake triage, policy screening, medical-record analysis, audit evidence, and adjudication support — with auditor oversight and PHI protection at the core, and no claim data in consumer AI tools.
Claim auditing is too important for slow manual workflows — or unsafe AI shortcuts.
Payer and audit teams face rising claim volume, evolving CMS guidance and payer-policy requirements, and strict expectations for protecting sensitive patient information. ClaimClean is built for the middle ground healthcare teams actually need: AI assistance with human oversight, explainable outputs, and privacy-first data handling.
Manual review doesn't scale
Detailed medical-record review can take weeks per case, while claim volume keeps growing faster than audit teams do.
Policy churn is constant
CMS guidance, coding standards, and payer policies keep changing — and applying them consistently by hand is difficult.
PHI raises the stakes
Sensitive medical records create real privacy and compliance risk in every workflow that touches them.
Unmanaged AI is a liability
Pasting claim data into consumer AI tools can expose PHI and produce outputs no auditor can defend.
Three modules. One evidence-driven audit workflow.
Anonymization Service protects sensitive patient information before analysis. Medical Fraud Filter screens claims against configurable rules, policies, and guideline checks. Audit Insights Assist analyzes medical records and generates evidence-rich reports for human reviewers.
Anonymization Service
Protects sensitive patient information before claim data is used for analytics, review, or AI-assisted workflows.
- Detect and reduce PHI exposure
- De-identification and redaction workflows
- Privacy-aware analytics and audit review
Medical Fraud Filter
Screens claims using configurable policy and guideline checks aligned with CMS guidance, payer policies, and internal audit priorities.
- Predefined and configurable rule sets
- Flag claims for deeper review
- Prioritized queues with explainable findings
Audit Insights Assist
Analyzes medical records, surfaces relevant evidence, and generates graphical reports that highlight potential review signals.
- Analyze claim documents and records
- Highlight potential fraud, waste & abuse indicators
- Visual summaries and evidence-backed reports
One platform across the claim review lifecycle.
ClaimClean is built to support U.S. health insurers end to end — from the moment a claim packet arrives to the report an adjudication team can act on, with team oversight throughout.
Secure intake & triage
Claim packets and records arrive through structured, controlled intake and are prioritized for the reviewers who need them first.
PHI protection
Anonymization Service minimizes and de-identifies sensitive patient information before anything downstream runs.
Policy & guideline screening
Medical Fraud Filter applies configurable checks aligned to CMS guidance, payer policies, and internal audit criteria.
Medical-record analysis
Audit Insights Assist analyzes records and surfaces potential review signals with the evidence behind each one.
Evidence & adjudication support
Evidence-ready reports give adjudication, appeals, and escalation teams findings they can validate and defend.
Oversight & collaboration
Managers track claim activity, team performance, and completion rates, while built-in messaging keeps auditors, providers, and admins on the same case page.
From raw claim packet to review-ready evidence.
Every stage keeps a human control point. ClaimClean surfaces signals and organizes evidence — qualified auditors validate findings and decide next actions.
- IntakeReceive the claim packet and associated medical records through secure intake.
- ProtectMinimize or anonymize PHI according to the workflow's data-handling needs.
- ScreenApply configured policy and guideline checks across the claim.
- SurfaceHighlight potential fraud, waste, abuse, or documentation inconsistency signals.
- ReportGenerate auditor-ready reports with supporting evidence and visual summaries.
- DecideA human auditor reviews, validates, and determines the next action.
Designed so compliance teams can say yes.
Healthcare AI is only useful if buyers can trust the workflow. ClaimClean is designed around PHI minimization, application-level security, human review, and explainable audit outputs.
Built for the teams that carry the audit burden.
Healthcare payers
Reduce manual review burden and bring consistency to high-volume claim audit workflows.
For payersTPAs
Scale pre-review and evidence generation across outsourced, high-volume claim operations.
For TPAsCost-containment firms
Accelerate audit throughput with configurable checks and exportable, defensible findings.
For cost containmentSIU & audit teams
Surface potential fraud indicators with the supporting evidence investigators need.
See the workflowEarly-stage, and serious about it.
ClaimClean is an early-stage InsurTech company focused on U.S. healthcare insurance claim audit workflows. We would rather earn trust with evidence than with hype.
- Founded by Shorya Shriwastav and Chirag Patil
- MVP developed and demo-ready
- Focused on U.S. payer, TPA, and cost-containment workflows
- Actively seeking payer, TPA, and BPO pilot partners
- Engaged with the U.S. InsurTech community, including InsurTech NY
Bring AI into claim auditing without removing auditor judgment.
Tell us about your claim volume and audit workflow, and we'll scope a pilot that proves value on your own cases.