- GitHub: pothuguntaumesh/MediFlow-UI
- Demo Video: Google Drive
- Website: https://v0-patient-onboarding-and-claims.vercel.app/
- Workflow Diagram: Architecture Diagram
Who:
Healthcare providers processing 3+ billion insurance claims annually
Pain Points:
- $25.7B spent on manual claims adjudication
- 40–50% require manual processing
- 12–20 minute verification calls per patient
- 15% denial rates costing $57.23 per appeal
Why Now:
- Post-COVID staffing shortages
- 23% cost increase in claims processing
- Growing demand for healthcare efficiency
📊 Sources:
Premier Inc. Claims Adjudication Report 2025
McKinsey AI in Insurance
The proposed AI-powered system introduces two integrated workflows that automate critical touchpoints in the insurance claims lifecycle.
- Patient admission triggers VAPI Agent
- Automated insurance verification call
- Real-time data extraction → Hospital dashboard population
- Integration with hospital systems
- Doctor inputs notes → AI agent performs document analysis
- Generates accurate medical codes automatically
- Completes insurance forms
- Claims processing with feedback loop and system updates
| Category | Description |
|---|---|
| Primary Care | Mid-to-large hospitals (100+ beds) |
| Secondary Care | Ambulatory surgery centers & specialty clinics |
| Setting | Intake departments (verification) + Billing departments (claims processing) |
| Users | Registration staff, medical coders, revenue cycle managers |
- ✅ HIPAA Compliance with audit logging, traceability, and fact-checking agents
- 🔊 VAPI integration for automated insurance verification (12–20 mins → 30 seconds)
- 🔁 End-to-end automation for both pre- and post-treatment workflows
- ⚡ Real-time processing replacing manual human calls
- 🧩 Self-learning AI continuously improves accuracy
- 🏥 Enterprise integration with Epic, Cerner, and Allscripts
- 🛡️ Regulatory-ready: HIPAA + SOC-2 compliance
| Metric | Current | Projected | Improvement |
|---|---|---|---|
| First-pass acceptance rate | 75% | 95% | +20 pts |
| Claims processing time | 7–14 days | 24–48 hrs | 85% reduction |
| Manual verification | 12–20 min | 30 sec | 97% reduction |
| Coding accuracy | 85% | 95% | +10 pts |
| Admin cost per claim | $57.23 | $15.00 | 74% reduction |
| Denial rate | 15% | 5% | 67% reduction |
Workflow Overview: View Diagram →
System Highlights:
- Real-time API orchestration
- Multi-agent pipeline for verification, coding, and adjudication
- Integrations with hospital EHRs and payor systems
- ROI: 6–8 month payback with $15/claim savings
- TAM: $45B addressable market in healthcare inefficiencies
- Community: Faster approvals, lower costs, sustainable operations
- Premier Inc. Claims Adjudication Report 2025
- McKinsey AI in Insurance
- VAPI Healthcare Applications
- AI Claims Processing Benefits — Beam.ai
- Medical Coding Automation — AI Health
- Real-Time Claims Processing — One Percent Steps
📘 Project Repository:
👉 https://github.com/pothuguntaumesh/MediFlow-UI