Claim identified
Policy and beneficiary
Type of care
Provider and date
Digital health reimbursement management
Turn every reimbursement claim into a complete, traceable case file
Digitize the claim and use artificial intelligence to validate documents during upload, detect missing information, and prepare a structured pre-validation before the case reaches the physician.
Digital reimbursement case file
Active traceability
1. Claim
2. AI validation
3. Pre-validation
4. Medical review
AI reviews every supporting document
Valid invoice
Legible physician order
Incomplete medical report
Correction before submission
AI validation Active
Continue Blocked
Insured member Correction required
A solution for the pre-review process
More than receiving documents: prepare complete cases for review
DANAconnect organizes data capture, supporting document intake, AI-powered document validation, observations, and communication with the insured member within a single journey.
The result is a digital case file with enough context to proceed to internal review or the system responsible for claims processing.
Data, documents, statuses, and interactions remain connected
Operations teams can understand what was received, what is missing, and what action comes next.
More complete claims
AI identifies incorrect, incomplete, or illegible documents before allowing the process to continue.
Tracking for both parties
Keep the insured member informed and provide context to the operations team.
Reimbursement journey
A guided experience from claim submission to a review-ready case file
Each stage can be configured according to the type of coverage, required documents, and the insurer's operational rules.
Registration
The insured member identifies the policy, beneficiary, care received, and reason for reimbursement.
Validated upload
AI immediately verifies that every file matches the requested document and is complete.
AI analysis
Classifies documents, extracts information, and checks consistency across invoices, prescriptions, reports, and other evidence.
Correction
If information is missing, the insured member receives a specific request to complete it.
Pre-validation
The physician receives a structured case with findings and alerts for professional review.
Artificial intelligence at critical points
AI improves case intake and the starting point for medical review
Automation does not wait until the back office to find problems. It validates documentation as the insured member uploads it and prepares the case file before sending it to the responsible professional.
Only allows the process to continue when required documents are correct
AI interprets every file in real time and guides the insured member in correcting issues before submitting the claim.
Recognizes the type of document uploaded
Checks legibility and the presence of required information
Detects incorrect, incomplete, or missing documents
Requests corrections before enabling the next step
Provides the physician with a structured pre-validation of the case
AI connects the evidence and prepares a summary so the professional can focus on the evaluation that requires clinical judgment.
Extracts relevant data from invoices, prescriptions, and reports
Analyzes consistency across different pieces of evidence
Flags inconsistencies, missing information, and early warnings
Case prepared for the physician
Summary, classified documents, findings, and items requiring review.
AI does not replace the physician: it assists them.
Pre-validation speeds up analysis and helps reduce bottlenecks, while clinical decisions remain under professional judgment.
The core of the product
A digital case file that preserves the full context of the case
The claim is no longer a scattered collection of forms, attachments, and messages. Every element remains associated with the same case to facilitate tracking, control, and audit.
Data provided by the insured member
Documents received and corrected versions
Observations, owners, and status changes
Communications sent during the process
Claim RS-2026-00481
Case file under review
Insured memberIdentified
Documents4 received
Latest actionCorrection
Provider invoice
Physician order
Clinical report
Proof of payment
Product capabilities
Configure the process according to your rules, documents, and review routes
The solution adapts to each insurer's requirements without turning every operational change into a separate development effort.
Configurable forms
Adapt fields, questions, and requested documents according to the reimbursement type.
AI-validated upload
Verify during upload that the file is correct, legible, and sufficiently complete.
Document understanding
Classify supporting documents, extract relevant data, and connect information across evidence.
Digital correction
Request corrections or additional supporting documents without restarting the process.
Statuses and notifications
Communicate receipt, review, observations, pending items, and case progress.
Pre-validation for the physician
Provide a structured case with findings and alerts to accelerate professional review.
One solution, two coordinated experiences
Self-service for the insured member and control for operations
A guided, easy-to-understand process
The insured member knows what to submit, what information is missing, and the status of the claim.
Registration through a link or digital portal
Immediate AI-powered document validation
Correction without repeating the entire claim
Status and pending-item notifications
Cases organized before claims processing
The team receives case files with associated data, documents, observations, and traceability.
Rules by product, coverage, or type of care
Visibility into incomplete or flagged claims
AI pre-validation before medical review
History available for control and audit
Configurable processes
Adapt requirements to the type of care and coverage
Not all claims require the same data or documents. The journey can vary according to the nature of the reimbursement.
Consultations and professional fees
Invoice, proof of payment, and provider or professional information.
Medication
Prescription, invoice, instructions, and documents required by the coverage.
Tests and procedures
Physician order, results, report, and supporting documents associated with the care.
Hospitalization
Itemized bill, medical reports, and additional case documentation.
Integration with your ecosystem
Orchestrate the process without replacing the systems responsible for policy administration or claims processing
DANAconnect can exchange data and statuses with existing systems to identify the insured member, register claims, route case files, and communicate outcomes.
Insured member portal
Web forms
Digital channels
DANAconnect
Data · documents · AI · rules · tracking
Insurance core system
CRM or BPM
Document management
Security and traceability
Protect information and retain evidence throughout the journey
Managing medical and personal data requires access control, action tracking, and an implementation aligned with the insurer's policies.
Controlled access
Define who can view, review, or modify case information.
Case file history
Record documents, observations, statuses, and the owners involved.
Communication evidence
Retain traceability of messages and requests sent to the insured member.
Configurable policies
Apply security and retention controls defined by the organization.
Frequently asked questions
What you need to know about the solution
Does the solution process reimbursement payments?
Not necessarily. It primarily optimizes intake, completeness, initial validation, and tracking, and can integrate with the system responsible for claims processing.
Can it request additional documents?
Yes. When the case file is incomplete or flagged, the insured member can receive a specific request to correct data or upload new supporting documents.
Can an analyst intervene?
Yes. Cases requiring judgment, presenting inconsistencies, or meeting special conditions can be routed for human review.
Can it connect with existing systems?
Yes. It can integrate with insurance core systems, CRM, BPM, document repositories, and other internal platforms through the available integration methods.
What does AI validate during upload?
It can recognize the document type, verify that it matches the requested supporting document, review legibility and completeness, and detect missing information or inconsistencies before enabling submission.
Does AI replace the physician's review?
No. AI classifies documents, connects evidence, and prepares a structured pre-validation. The physician retains responsibility for professional review and judgment.
Turn reimbursement claims into a complete digital process
Show insured members what they need to submit and provide operations teams with more complete, organized, and traceable case files.
Request a demo