NEXUSNOVA|v1.0|ONLINE
IST--:--
22d → 9d follow-up · denials -30%
packet 71%→96% · denial predictor · corporate pipeline
TPA 15–30 day cycles + Ayushman packet errors are ops drag, not payer drag. HospitalOS does OCR on packets, RPA on TPA portals, and predicts denials — claim tracker from pre-auth to settlement.
> _cost: 22d follow-up · denials 28%+ · 29% packets incomplete · corporate referrals ad-hoc
> _hospital_invariants
Claim is a pipeline, not a folder. OCR + rules validate, RPA follows portals, tracker predicts.
01 · OCR + rule engine (packet validator)
OCR on pre-auth, bills, reports. Rules check Ayushman/TPA completeness 71%→96% before RPA submit.
> FHIR Claim + Coverage
02 · TPA portal RPA + tracker
RPA follows pre-auth → settlement on TPA/Ayushman portals. Every claim has status + SLA.
> Portal RPA → FHIR ClaimResponse
03 · Denial predictor
Model flags missing docs/codes pre-submit — denials -30% (-28% pilot).
> ML + FHIR Claim validation
04 · Corporate & referral pipeline
Corporate tie-ups + doctor referrals in CRM with SLA. Recovery timeline 22d→9d.
> CRM + FHIR ServiceRequest
Packet completeness depends on lab/pharmacy source data — linked, not duplicated.
Lab reports auto-attach to packet; missing labs flagged pre-RPA — no denial for 'report not attached'.
Pharmacy charges FHIR-synced to claim; discharge handshake ensures bill = meds actually dispensed.
Discharge e-summary + ADT timeline attach automatically; packet 71%→96% without extra typing.
> OCR + RPA + FHIR Claim · packet validator · denial model
Tech: FHIR Claim, Coverage, ClaimResponse, ServiceRequest · TPA RPA · OCR + rule engine · FHIR R4 · Denial predictor · Audit trails per claim · India residency · RBAC + logs · NABH billing trails
Hospital — Revenue Cycle
TPA claim lifecycle 18-28 days with manual portal follow-up and packet errors.
Follow-up 22d→9d, denial rate -28%, packet completeness 71%→96%.
Yes — validator covers Ayushman + TPA with portal-aware rules (pre-auth, reports, codes). Packet 71%→96% in pilot.
RPA is monitored per portal; selector updates + OCR fallback keep tracking live. SLA-backed ops pod handles portal drift.
Yes — claim tracker links to ADT Encounter + discharge Task. One timeline: admit → discharge → packet → settlement.
Parallel run with no downtime. Discovery 1–2w, phased 3–6w, SOP handover and 99.9% SLA.