Five products, one pipeline — CognitoScan, CognitoAdjudicate, CognitoShield, CognitoPredict, and CognitoBridge. Built to serve both sides of the claim: the insurer deciding it and the provider submitting it.
The claim starts as paper — or a photo of paper. Our ingestion models are trained for the real documents of this region: handwritten referral letters, mixed English-Chinese-Malay bills, hospital formats that change by department.
Extracted data is coded against medical knowledge — diagnoses, procedures, drugs, length of stay — and checked for clinical coherence. A diagnosis that doesn't match the procedure gets flagged before it becomes a wrong decision.
Benefit schedules, riders, exclusions, waiting periods, panel rules, and fee benchmarks — encoded and applied automatically. Clean claims go straight through. Ambiguous ones arrive at your assessors pre-analysed, with the hard work already done.
Dedicated models watch for billing anomalies, unusual utilisation patterns, and fraud signals across claims — not to auto-deny, but to route the right claims to investigators with the evidence attached.
For hospitals, clinics, and TPAs: CognitoClaims scores claims before submission, predicts likely denials, and shows exactly what's missing — turning weeks of rework into a fix before the claim ever leaves the building.
The trail is the product. Every decision records the clauses applied, the benchmarks referenced, the model version used, and any human override — immutable, exportable, and ready for your auditors and your regulator.
The engine is only useful if it reaches your claims — and your claims live in core systems, TPA platforms, and hospital software that were never designed to talk to each other. CognitoBridge harmonises data across them and exposes clean, dynamic APIs so the platform drops into your stack instead of replacing it.
Straight-through processing for clean claims, pre-analysed queues for the rest, and fraud signals with evidence — inside your own environment.
Denial prediction, coding gaps, and missing documents caught before submission. Faster reimbursement with fewer disputes.
Automate the volume, keep the judgment. Handle more members and more claims without scaling headcount linearly.
We'll map the engine to your claim types, your documents, and your rules.
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