For Insurance Companies & Payers
Purpose-built claims adjudication, fraud detection, and revenue cycle management for insurers operating across Africa and the Caribbean. Reduce leakage, settle faster, and grow your member base with native payer adapters for every major scheme.
From eligibility checks at the front desk to remittance reconciliation at month-end — one platform handles it all.
Review, approve, or deny submitted claims from a single queue with fraud score badges and full claim history. Auto-adjudicate clean claims that meet your rules engine criteria, freeing your team to focus on the exceptions that require human judgment.
Rule-based and ML-powered fraud engine flags duplicate billing, upcoding, ghost patients, and provider velocity anomalies in real time. Each flagged claim shows an explainable risk score so adjusters can make fast, defensible decisions.
Digital pre-auth workflows cut turnaround from days to minutes. Providers submit requests with clinical evidence attached; your team approves, denies, or requests more information from a single dashboard with real-time payer adapter integrations.
Instant coverage checks against CNSS, NHIS, CNPS, IPM, and private insurer databases. Eligibility results are cached for 24-hour SLA compliance. Providers see coverage status at check-in so there are no surprises at billing time.
Upload remittance files and automatically match payments to claims, surfacing variances and disputed amounts. Track AR aging by provider, facility, and region so your finance team always knows where money is — and where it isn't.
Track fraud rate, AR aging buckets, denial codes, first-pass rates, and provider utilization trends in real time. Exportable reports formatted for regulators, board presentations, and actuarial teams across every market you serve.
Native adapters for public health schemes, mutuals, and private HMOs — no custom integration work required.
CNSS AMO, CNOPS, RAMED
NHIS, Hygeia HMO, AXA Mansard, Reliance HMO
CNPS, AXA Cameroun, Activa
IPM, IPRES, AXA Senegal, Allianz
Jamaica NHF, T&T NHIS, Sagicor, Guardian Group
From claim submission to settlement — three steps to faster reimbursement.
Providers submit claims directly from their Cari EHR — diagnoses, procedures, and supporting documents arrive pre-coded and validated. Your payer adapter normalizes the data to your internal format, regardless of which scheme the patient belongs to.
The rules engine processes each claim against your benefit design, fee schedules, and fraud detection models. Clean claims are auto-approved. Suspicious claims surface in a review queue with explainable risk scores and one-click approve/deny actions.
Approved claims generate payment instructions grouped by provider and settlement cycle. Upload bank remittances to auto-match payments to claims. Your finance team sees a real-time AR dashboard with aging buckets and variance alerts.
Grow Your Member Base
Your insurance plans appear inside the Cari patient app — patients browse, compare, enroll, and pay without leaving their health record. Reach the 97% of Africans who are still uninsured with a distribution channel that meets them where they already manage their healthcare.
Join insurers across Africa and the Caribbean using Cari to process claims faster, catch fraud earlier, and grow their member base.