Hutano AI is the real-time fraud and authorization firewall for medical aids. It scores every electronic and paper claim before you pay, explains every flag, and gives your investigators a console to act, hosted in-country.
Every medical aid pays claims it should never have paid. Fraud, waste and abuse are detectable at submission, yet most aids only find them after payment, if at all.
Sources: CIMAS Health Group / allAfrica; ZimLive, Zimbabwe Independent, Newsday; Health Funders Association, Daily Maverick, Council for Medical Schemes. Zimbabwe figures are executive estimates, not audited totals; the SA 15–20% is a labelled regional proxy. We do not estimate a figure for your book, we baseline it with you, from your data.
Hutano AI sits between the switch (and scanned paper) and your adjudication system. Advisory and fail-open by design, a slow or failed score never blocks a legitimate claim.
A hybrid of deterministic rules, peer benchmarking and ML anomaly detection, blended into one explainable score.
A fraud firewall handles health data. We treat that as a first-order constraint, not an afterthought.
Not a dashboard of charts, a tool your Special Investigations Unit works in every day.
We ingest a feed of your claims and score everything. It takes no action, nothing is held, declined or delayed. Your adjudication runs exactly as it does today.
A batch export, a tee from your receiver, or a live copy, plus a paper sample.
We hand your team the top flags; they tell us signal vs noise, and we tune.
What we caught, what it would have saved, the false-positive rate on your book.
Advisory & fail-open, expanding only as accuracy holds. You decide.
Hutano AI is productized from infrastructure Avalon Health already runs in production in this exact claims pipeline, a Health263 integration, a real-time switch adapter, and the Zimbabwe ZRVS tariff schedule (7,930 codes). We reuse proven parts, not a vendor starting cold.
Tell us your process and we fit into it. One session with your claims and IT leads is enough to agree the feed and start the three-month shadow pilot, at no cost, no operational change.