MUMBAI, India, Feb. 13 -- Intellectual Property India has published a patent application (202521117138 A) filed by Rajarambapu Institute Of Technology, Sangli, Maharashtra, on Nov. 26, 2025, for 'generative ai framework for automated healthcare claim adjudication, fraud detection, and policy optimization.'
Inventor(s) include Dr. Amol Chandrakant Adamuthe; Smita Maruti Jadhav; Diksha Dilip Patil; Vaishnavi Bibhishan Sawant; and Abdul Haq.
The application for the patent was published on Feb. 13, under issue no. 07/2026.
According to the abstract released by the Intellectual Property India: "This invention describes a Generative AI-powered framework for healthcare claim management, designed to automate and optimize end-to-end claim adjudication. Leveraging Large Language Models (LLMs), Retrieval-Augmented Generation (RAG), Optical Character Recognition (OCR), and Natural Language Processing (NLP), the system digitizes unstructured medical and policy data, validates claim eligibility, detects fraud, and auto-generates appeal letters for denied claims. It employs a vector-based knowledge repository for real-time policy matching and semantic search, ensuring decisions are explainable and compliant with regulatory standards. The framework integrates a human-in-the-loop feedback mechanism to continually improve AI models using validated outcomes. This innovation minimizes manual intervention, enhances operational efficiency, and reduces administrative costs, enabling insurers to deliver faster, more accurate claim settlements while ensuring transparency, accountability, and trust in automated decision-making processes across the healthcare insurance ecosystem."
Disclaimer: Curated by HT Syndication.
