Five parties to a claim.
One engine underneath.
An insurer, a hospital, a government scheme, a farmer and a claimant all touch the same claim, at different points and for different reasons. AXK gives each of them a different answer, from the same rules engine and the same audit trail.
- party_role
- enum
- decision
- reason
- settled_via
- mobile money
Insurers
Private insurers writing health, motor, agriculture, property, liability and life.
What breaks todayAdjudication is manual, so the cost of settling a claim scales with the number of claims. Fraud is caught late, if at all, and slow payouts cost renewals.
See every line of business insurers write on AXKAdjudication that scales without headcount
Claims that satisfy the rules and clear the fraud model settle without a reviewer. Your team spends its time on the claims that actually need judgement.
Fraud caught at submission
Every claim is scored before it enters the queue, against billing patterns, duplicates and claimant history. You review the flagged ones, not a random sample.
Retention you can point at
A policyholder who is paid quickly and told why renews. Settlement speed is a product feature and AXK makes it one you can operate.
Hospitals & clinics
Providers billing insurers and public health schemes for treatment already given.
What breaks todayYou treat the patient, submit the claim, and wait. Payment is unpredictable, resubmissions are common, and the reason for a rejection often arrives weeks after the encounter.
How a health claim moves through AXKCashflow you can plan around
Claims are adjudicated against the medical record when they are filed, not weeks later. You know the state of every claim while the encounter is still fresh.
Fewer resubmissions
A claim missing a field or an attachment is rejected at submission with the gap named. You fix it in minutes instead of discovering it after a month.
Reimbursement over rails you already use
Payment lands over bank transfer or mobile money, carrying the claim id. Reconciliation is a lookup.
Government & social insurance
National schemes, health ministries and regulators carrying public cover.
What breaks todayA public scheme runs a deficit it cannot fully explain, because claim data arrives late, inconsistent and after the money is gone. Fraud and duplicate billing are suspected and hard to prove.
How a health claim moves through AXKClaims data that arrives clean
Claims are structured, typed and validated at submission. The scheme sees what was claimed and what was paid as it happens, not in a quarterly reconciliation.
A path to scheme sustainability
Fraud scoring and rules-based adjudication attack the two costs that break a public scheme: leakage and administration. Both are visible in the audit log.
Digitisation that pays off
The EMR rollout produces machine-readable clinical evidence. AXK is the layer that turns it into a settled claim, which is the return the rollout was funded on.
Farmers & cooperatives
Smallholders and aggregators carrying index-based cover against weather shocks.
What breaks todayCover exists but the payout arrives months after the harvest it was meant to protect. Verification costs more than the claim, so the smallest farms are not written at all.
How index-based agriculture cover pays outNo claim to file
Cover pays against a weather index, not an inspection. When the threshold is breached, the trigger fires for every policy in the area.
Money before the next planting
Payout is calculated from the index reading and settles over mobile money. The point of the cover is the next season, so it arrives in time to fund one.
Cover that is worth writing
Removing field verification removes the cost that priced smallholders out. Donor and government subsidy can then sit on a claims process that can be audited.
Citizens
Policyholders, patients and beneficiaries on the receiving end of a claim.
What breaks todayYou paid the premium. When you need the cover, you are asked to carry papers between offices and wait without being told why.
Every line of business a claim can come fromA decision with a reason attached
Approved or flagged, the claim tells you which rule it hit and what is missing. No unexplained rejection.
Payment to the phone you already have
Settlement lands over mobile money. There is no branch to visit and no account to open.
Fewer errands
Where the evidence exists in a registry, AXK reads it there. A family claiming on a life policy should not have to prove a death the state already recorded.
Tell us which side of the claim you sit on.
Insurer, provider, government scheme, cooperative or claimant, the rules engine underneath is the same one. What changes is the conversation.