AI Health Insurance Claim Processing & Data Extraction Software

Automating their processes with AI

Affinda has removed the laborious workload from our accounts staff, who now focus on quality assurance and management of any outliers.

- Nathaniel Barrs, CTO, PSC Insurance

95%

reduction in manual work

10×

more invoices processed with no added staff

Enhanced auditability and tracking of invoice approvals

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Customer satisfaction is always our top priority, and Affinda has helped us achieve that by eliminating phone calls, manual handling, and delays.

- Jorg Both, Head of Business Systems, Northline

120,000

proof of delivery documents processed annually

82%

of documents straight-through processed in the first weeks

Automatic validation of documents against ERP system

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Two recruitment specialists reviewing a list of candidates

Affinda's ongoing improvements in its AI models demonstrate its innovative approach in Document AI.

– Michael Zhao, AI Product Manager, SEEK

High accuracy parsing across multiple languages
Improved customer experience thanks to better structured data
Stronger compliance with international data security and software standards

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Affinda’s support and expertise were invaluable… The experience working with Affinda was excellent.

- Nick Tran, Business Analyst, StateCover Mutual

300,000

documents processed annually

80

different document types

60%

Enhanced auditability and tracking of invoice approvals

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Logistics manager reviewing paperwork onsite

The results have spoken for themselves. I recommend Affinda to anyone looking to enhance their product or business with AI capability.

- Steve O’Keeffe, CTO, Felix

76%

reduction in manual data input

30%

reduction in compliance data errors

85,000

compliance documents processed annually

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Frequently asked questions

What is health insurance claim processing?

Health insurance claim processing is the workflow healthcare providers and insurers use to receive, extract, validate and approve data from medical claim forms like CMS-1500 and UB-04. Affinda's AI health insurance claim processing software automates this entire workflow – reducing manual effort, speeding up reimbursements and minimizing errors. It ensures claim data is accurate, compliant and ready for your billing, EHR and insurance systems.

What is health insurance claim data extraction?

Health insurance claim data extraction is the process of reading medical claim forms like CMS-1500 and UB-04 and capturing critical data points – including patient details, provider information, diagnosis codes, procedures, charges and insurance details. Affinda's AI automates health insurance claim data extraction, handling complex tables and multi-page forms to transform unstructured documents into structured data ready for your claims, billing and EHR systems.

What is health insurance claim extraction?

Health insurance claim extraction is the automatic capture of key data from medical claim forms using AI. Our health insurance claim extraction software combines reading order models, OCR, LLMs, RAG and more to convert claim information with high accuracy and faster processing times.

What is an health insurance claim parser?

A health insurance claim parser is software that automatically reads and extracts data from medical claim forms. It converts claims into structured, machine-readable formats your systems can use. Affinda's AI health insurance claim parser learns from every interaction – adapting to variations in layout, format and custom forms with ease while transforming the output into exactly the format your downstream systems need.

What is health insurance claim line extraction?

Health insurance claim line extraction captures procedure and charge data from tables within claim forms – turning it into structured, usable data while preserving the relationships between diagnosis codes, procedures and charges. Affinda's complex table capability reads everything from simple grids to multi-line procedure groups, maintaining the connections your billing and claims systems need.

What data fields can Affinda’s AI health insurance claim processing software extract?

Affinda's AI health insurance claim processing platform can capture data from any field on a medical claim form. Standard data fields include:

Patient Information

Patient Name: Full name of the patient receiving care.
Patient ID / Medical Record Number: Unique identifier assigned by the provider or health system.
Date of Birth / Age: Patient's birth date or age at time of service.
Gender: Patient's sex or gender identity when documented.
Patient Address / Contact Information: Residential address, phone number and contact details.

Provider Information

Provider Name / Organization: Healthcare provider or facility delivering care.
NPI / Provider ID: National Provider Identifier or facility tax ID number.
Provider Address: Billing and service location addresses.
Referring / Supervising Provider: Names and identifiers for referring or supervising physicians.

Claim Details

Claim Number / Control Number: Unique identifier for the claim submission.
Service Date / Admission Date: Date or date range when services were provided.
Place of Service: Code indicating where care was delivered.
Claim Type: Professional (CMS-1500), institutional (UB-04) or other format identifiers.

Diagnosis & Procedures

Diagnosis Codes (ICD-10): All diagnosis codes with appropriate sequencing and pointers.
Procedure Codes (CPT / HCPCS): Service and procedure codes from claim line items.
Modifiers: Additional codes that modify procedure or service descriptions.
Units / Quantity: Number of units or days for each procedure line.

Charges & Billing

Charge Amount: Billed amount for each procedure or service line.
Total Claim Amount: Sum of all charges on the claim.
Prior Payments / Adjustments: Previous payments or balance adjustments when documented.

Insurance Information

Insurance Carrier Name: Name of the payer or insurance company.
Policy / Group Number: Insurance policy and group identifiers.
Subscriber Name / Relationship: Policyholder name and patient's relationship to subscriber.
Prior Authorization / Reference Numbers: Pre-approval codes and payer reference numbers.

Need custom fields or industry-specific data points? Simply define them in the UI or describe them in natural language and Affinda will extract and structure them automatically.

What file types does Affinda’s AI health insurance claim processing solution support?

Our AI agents can process any file type.Supported file types include PDF, JPG/JPEG, PNG, TIFF, DOC/DOChealth insurance claim (Word), health insurance claimLShealth insurance claim (Excel), HTML and Thealth insurance claimT/CSV.

How does Affinda process health insurance claims and extract health insurance claim data?

Affinda's AI agents read, extract and validate health insurance claim data. Our platform is intuitive to set up and easily integrates into your systems. Simply:

Upload your health insurance claims via drag-and-drop, email or API.
Configure business logic to match your organization's rules and workflows.
Let Affinda check and validate extracted data against your business logic and claims management, billing, EHR or insurance systems to ensure accuracy.
Access structured health insurance claim data directly within your systems.

The result? Faster, more accurate health insurance claim processing with minimal manual input.

Can Affinda extract data from scanned or image-based health insurance claims?

Yes. Our AI health insurance claim processing platform combines OCR with retrieval augmented generation (RAG), LLMs, agentic workflows, proprietary reading order algorithms and more, to automatically detect and process data from scanned or photographed invoices (PDF, JPG, PNG). Even low-quality images are automatically enhanced for reliable data capture and processing.

What language does Affinda’s AI health insurance claim automation platform support?

Our AI health insurance claim processing platform can automatically detect and process health insurance claims in 50+ languages, including multilingual health insurance claims containing more than one language.Supported languages include: Afrikaans, Albanian, Amharic, Arabic (Standard, Egyptian, Sudanese, Algerian, Moroccan, Levantine), Bahasa Indonesian, Bengali, Bhojpuri, Bulgarian, Burmese, Chinese (Mandarin [PRC/Taiwan], Cantonese, Wu, Min Nan, Jinyu, Xiang, Hakka), Croatian, Czech, Danish, Dutch, English, Estonian, Finnish, French, German, Greek, Gujarati, Hebrew, Hindi, Hungarian, Italian, Japanese, Javanese, Kannada, Korean, Latvian, Lingala, Lithuanian, Macedonian, Malayalam, Marathi, Nepali, Norwegian, Odia, Persian (Farsi), Polish, Portuguese, Punjabi (Western and Eastern), Romanian, Russian, Slovak, Slovenian, Somali, Spanish, Swahili, Tagalog, Tamil, Telugu, Thai, Turkish, Ukrainian, Urdu, Vietnamese, Yoruba.

Does Affinda integrate with claims, billing and EHR systems?

Yes. Affinda integrates seamlessly with claims management, billing, EHR and insurance systems – plus 400+ other platforms. You can build no-code integrations using our AI integrations agent or connect using our APIs, giving you the flexibility to fit health insurance claim processing into your existing workflow.

What are some examples of AI health insurance claim workflow automations?

AI health insurance claim processing automates and streamlines healthcare workflows across departments such as:

Claims Operations: Speed up adjudication and reduce errors by extracting patient, provider, diagnosis and procedure data from CMS-1500 and UB-04 forms – including complex tables and multi-page submissions. Business-rule validation flags claims needing review, catching missing authorization codes, diagnosis mismatches and duplicate submissions.
Medical Billing / Revenue Cycle Teams: Use self-learning AI that adapts to form variations, simplifying charge capture and improving reimbursement timelines while reducing denials.
Insurance / Payer Teams: Feed structured claim data into your existing systems to enhance accuracy, compliance and operational scalability across high-volume claim processing.

What is an health insurance claim OCR data extractor?

A health insurance claim optical character recognition (OCR) data extractor scans and captures information from medical claim forms such as CMS-1500 and UB-04, regardless of format or layout. Upload claim documents in PDF, JPG or PNG formats. The OCR technology first converts the documents into a text layer, ensuring all text (even from scans, photos or handwritten forms) is captured. Affinda's AI models then identify and extract key fields such as patient details, provider information, claim numbers, diagnosis codes, procedures, charges and insurance details, transforming them into structured, usable data.This automation eliminates manual data entry, reduces errors and speeds up reimbursements. Once the claim data is captured and structured, our AI health insurance claim processing pipeline can apply business-rule validation and post-processing to enable seamless integration with claims management, billing, EHR and insurance systems.Healthcare providers, insurance companies and medical billing teams rely on Affinda's AI for their claims operations, revenue cycle management and compliance processes, streamlining workflows and improving overall efficiency.

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The AI platform for health insurance claim processing

How to automate health insurance claim processing with Affinda's AI

Upload your health insurance claims, your way

Watch as it extracts your health insurance claim data

Automatically route the data to your systems

Extract any information from any document, fast

Create models in seconds

Cleanse and transform data

Apply business logic

Pathway 1: Use our AI integrations agent

Pathway 2: Write your own code

Get AI agents to process your health insurance claims

Automate health insurance claim processing with 99%+ accuracy

See ROI in weeks, not months

AI that instantly learns from your health insurance claim and adapts

Easy integration, zero disruption

Configure your health insurance claim model, customize and maintain control

Enterprise-grade security

Combine the best of artificial and human intelligence

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Automating their processes with AI

95%

10×

120,000

82%

300,000

80

60%

76%

30%

85,000

Try AI health insurance claim processing for free

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