Claim Status Bot
Status, timeline, pending items
AI chatbot for
Medical Claims
Members, Adjusters, and Providers
When medical claims customers ask about claim status & timeline, pre-authorization requests, and document collection after hours, someone still needs to reply. NIVA answers from your own info, books the next step, and notifies your team · so warm enquiries do not go cold overnight.
- No usage-based billing
- Live across 25 industries
- White-label ready
70%
Query Deflection
24/7
Member Coverage
0
Code Required
Built for
Health InsurersTPAsClaims AdministratorsEmployer Plans
Where medical claims teams lose money every week
Not a tech problem. Missed replies, repeated FAQs, and overnight drop-off · on the website you already run.
They write while you're busy
A medical claims enquiry about pricing or availability lands while you're with a customer · and dies in the inbox.
Your team repeats the same answers
Hours go to FAQs on phone and chat. Quotes, visits, and sales wait behind the queue.
Warm leads cool overnight
Night and weekend visitors leave with no next step. By morning they've booked someone who replied.
Work your Medical Claims team still does by hand
Routine medical claims questions, bookings, and follow-ups · answered on the website so your people stay on the hard cases.
- 01
Claim Status & Timeline
Members and providers check adjudication status, pending items, and expected completion dates without calling the claims desk.
Status · Pending Docs · SLA · Timeline
- 02
Pre-Authorization Requests
Guide pre-auth eligibility, collect clinical codes, and open authorization cases with structured FNOL-style intake.
Pre-Auth · Procedure Codes · Eligibility · Intake
- 03
Document Collection
Send upload links for discharge summaries, invoices, and supporting records, and track what's still missing per claim.
Upload Links · Checklists · Reminders · Completeness
- 04
Coverage & Benefit Verification
Answer deductible, co-pay, and procedure coverage questions from plan documents, with clear escalation to human review.
Coverage · Deductible · Co-Pay · Plan Rules
- 05
Provider & Network Queries
Help providers confirm network status, fee schedules, and claim submission requirements through chat.
Network · Fee Schedule · Submission · Remittance
- 06
Fraud & Duplicate Triage
Flag duplicate submissions, inconsistent dates, and high-risk patterns for adjuster review before payout.
Duplicates · Risk Flags · Adjuster Queue · Triage
Questions your medical claims site already gets
Answered from your docs and policies · days, nights, weekends · so your team isn't repeating them.
What's happening with my claim CN-2024-88761? I submitted it two weeks ago.
What documents do I need to submit for a knee arthroscopy pre-authorization?
Not another chatbot.
A front desk that works overnight.
Missed enquiries after hours
Every website visitor gets a reply · days, nights, weekends
Your team repeats the same answers
Policies and pricing answered from your docs · consistently
Leads cool off waiting for a call back
Bookings, forms, and next steps happen in the chat
Teams already using NIVA
Ready-made medical claims helpers
Sales, support, bookings · switch on the roles you need. No writing from scratch.
Pre-Auth Coordinator
Eligibility, codes, intake
Document Collection Agent
Uploads, checklists, chase
Benefits Advisor
Coverage, deductibles, co-pay
Provider Support Bot
Network, fees, submission
Fraud Triage Agent
Duplicates, risk scoring
+ 4 more medical claims roles available
Built around how medical claims teams work
Practical pieces that save time · not a pile of AI features to configure.
Plan & Policy Knowledge Base
Upload plan summaries, clinical policies, and provider manuals. NIVA answers from approved wording only.
Member & Claim Context
Returning members continue with open claim references, pending documents, and prior answers in context.
Pre-Auth & FNOL Flows
Automate intake, document chase, and adjuster handoff sequences with automatic updates to your claims system.
Claims Platform Integration
Connect to claims, TPA, or policy systems for live status and structured write-back.
Claim Status & Document Chase Flow
Trigger
Member asks status for claim CN-2024-88761
Lookup
Under review, discharge summary pending
Action
Upload link sent, reminder scheduled
Claims
Document received, adjuster notified
What visitors can actually get done
Beyond FAQs · for medical claims businesses that sell and support online.
Stop chasing
Work finished in the chat
Collect the right details, book the appointment, and notify your team · without bouncing visitors to another form.
See how it works Capture cleanlyDetails you can act on
When someone is ready, the chat asks for name, dates, budget, or requirements · and lands it in your inbox or CRM.
See how it works Feel humanThe right helper, every time
Sales, support, or bookings · visitors get the specialist answer they need, without choosing menus.
See how it worksTonight's visitors get answers. You set it up once.
From a short setup call to live chat on your member portal in under a day, within your claims compliance boundary.
- 01~15 min
Show us where leads slip
Website, WhatsApp, ads · we map the medical claims questions that cost you money when nobody answers.
- 02Your call
Switch on the right helpers
Sales, support, bookings · pick personas that already speak medical claims. Turn off what you don't need.
- 03Your docs
Feed it what you already trust
Price lists, FAQs, policies, page links. It only answers from what you approve · nothing made up.
- 04Same day
Go live as your brand
One line on the site you already run. Overnight visitors get replies while your team sleeps.
On your website. Looking like your brand.
Works on the site you already have · WordPress, Webflow, Shopify, or custom. Your logo, your colours, your name. Most owners are live the same week they start.
- No big rebuild of your website
- Changes show up for visitors without a re-launch
- We can add it with you on the demo call if you prefer
- Do I need a developer?
- Helpful if you have one · not required. Many medical claims teams paste one line or let us place it.
- How fast will I see value?
- Most start capturing overnight enquiries in the first week once knowledge and booking paths are set.
- What if it's not a fit?
- Tell us how you work today. We'll say plainly if a simpler setup or a rival product is better.
Compliance & Security
Built for regulated medical claims environments.
- HIPAA Aligned
- GDPR / Privacy
- ISO 27001 Aligned
- PHI Handling Controls
Common questions
Straight answers before you start.
Yes. NIVA connects via REST API to surface claim status, pending documents, and write back intake data to your claims system.
Still unsure? Send a short note about how you work · we'll reply with a fit recommendation for medical claims.
Try NIVA free for Medical Claims
Spin up a medical claimschatbot on your site this week · or send a short note and we'll tell you honestly if it's a fit.
- Free to start · no credit card required
- Works on the website you already have
- We reply within one business day if you inquire
Prefer to ask first?
Tell us how enquiries come in today. We'll reply with a fit recommendation.
Solutions Focus
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