About Mediclaim AI

Mediclaim AI builds Pulse Coder, an AI-powered inpatient medical coding platform designed specifically for Revenue Cycle Management (RCM) companies and hospitals.

Every hospital stay in the United States must be translated into ICD-10 diagnosis and procedure codes before the hospital gets paid. These codes determine the MS-DRG (Medicare Severity Diagnosis-Related Group), which is the single number that sets reimbursement. Getting the DRG right means the hospital gets paid correctly. Getting it wrong means denied claims, underpayment, or audit flags.

Today, this work is done manually by trained medical coders who cross-reference discharge summaries, operative notes, labs, and progress notes against 160,000+ codes, severity tables, penalty rules, and payer edits. A typical inpatient coder processes 15 to 20 charts per day, each taking about 25 minutes. The industry faces a 30%+ vacancy rate with no relief in sight.

What Pulse Coder does

Pulse Coder is a three-panel coding workspace that runs entirely on AWS. Clinical records load on the left. The AI reads documentation and pre-codes the encounter with ICD-10-CM diagnoses, ICD-10-PCS procedures, POA indicators, and discharge disposition. Every code is linked directly to the exact evidence in the source text.

As coders work, 36 compliance rules fire in real-time. This covers MCE edits, Excludes1/2 violations, code-first requirements, POA enforcement, HAC penalties, and CC/MCC exclusions. The official CMS MS-DRG v43.1 grouper runs on every code change, showing the DRG, relative weight, and estimated payment live before the claim is ever submitted.

The coder reviews the AI output, makes adjustments based on their clinical expertise, resolves physician queries, and submits. A tedious 25-minute chart becomes a highly accurate 5-minute review. The full audit trail is logged for OIG and RAC compliance.

Who we serve

Our primary customers are RCM companies and health systems managing high volumes of US hospital charts. These teams face a constant battle: strict accuracy SLAs, growing daily volumes, and a severe shortage of experienced inpatient coders.

Mediclaim AI acts as a force multiplier for these coding departments. By automating the routine data-mining and highlighting exactly where the clinical evidence lives, we empower coders to process charts significantly faster without sacrificing accuracy. We shift the coder's daily job from hunting for data to performing expert clinical review.

Technical foundation

Pulse Coder is not a generic wrapper around an LLM. We built the actual, strict rules engine that CMS and payers use to adjudicate claims. CC/MCC severity is computed only after applying the PDX exclusion table (180,000+ code pairs). HAC penalties are detected automatically. 78,000 procedure codes are validated against MCE surgical edits and coverage rules. The MS-DRG grouper runs natively with both diagnoses and procedures on every single edit.

All code data comes from official CMS sources for FY2026. The platform supports multi-fiscal-year databases and automatically loads the correct data based on the discharge date.

Company

Mediclaim AI is a product of Psynapsis AI LLP, based in Kochi, Kerala. We were incubated at NSRCEL, IIM Bangalore. Our infrastructure runs on AWS with HIPAA BAA signed. The platform is HIPAA compliant by design, with the validator engine processing only codes, not patient identifiers.