From policy document
to automated claims operation
Zealthix replaces your entire manual claims and OPD operations stack with AI from plan configuration to claim decision to provider payment.
Upload Your Policy
Zive reads your OPD policy document and configures a live benefit plan copay rules, sub-limits, exclusions, and provider network in under 10 minutes.
Claims Arrive via NHCX
OPD and IPD claims flow in from providers via NHCX or direct API. Zudy enriches each claim with policy data, member history, and provider profile automatically.
AI Decides in Seconds
Fraud scoring, eligibility, tariff, and benefit checks run simultaneously. Approved amount calculated and decision issued with full audit trail standard claims in under 5 seconds.
Providers Settled T+20
Approved claims batched into payment runs at end of day. Settlement sent to bank, advice delivered to providers. Your operations team monitors they don't process.
