Ask the eligibility questions before the Session.

When the Claim arrives, it carries the policy version, Practitioner check, delivered Session and required evidence that produced it.

Book a Demo See what is open

Every Rejection is a question somebody failed to ask earlier.

So we ask all of them first. Here is one Claim, in the order the questions get answered.

#EventWhat was establishedWhen

01Eligibility checkedMember and Benefit confirmed against your rulesAt the booking
02Practitioner verifiedLicense checked against the Board that issued itAt the booking
03Session deliveredAttendance and duration recorded by the Room itselfThe hour
04Note approvedDrafted in the clinical format, approved by the PractitionerThe hour
05Claim assembledBuilt from the Session that produced it, not written up laterOn approval
06SubmittedStructured, complete, and already checked against 01Same day

Rows 01 and 02 preserve the eligibility and Practitioner evidence that row 06 depends on.

A typed adapter maps the Heyrafiki Claim to the agreed insurer format.

Reconciliation evidence stays beside each exchange.

FHIR
ICD-10
REST and OpenAPI
Webhooks

A Claim requires evidence from separate steps.

Eligibility, Practitioner standing, delivered Care and approved documentation keep their sources and times visible for fraud review.

Attendance keeps its source
Online Sessions can contribute system-recorded timing evidence; in-person attendance follows an explicit confirmation path with its source recorded.
The license was live
Checked against the issuing Board at the moment of booking, and re-checked on a standing schedule.
A named Practitioner approved it
Approval is recorded against a real, license-checked person, with the Client's consent captured before Iris drafted a line.
The Member was eligible first
Confirmed against your rules before the hour, so eligibility is never something asserted after the fact.

Each one is written by a different party, at a different moment, and none of them by the person being paid.

Three costs that stop being yours.

Measure avoidable rework
Checking eligibility and required evidence earlier removes avoidable rework before adjudication. Pilot evidence can measure return, resubmission and query rates against the insurer's baseline.
A network you can actually name
Every Practitioner is license-verified against the issuing Board, and re-checked. You know exactly who your Members are seeing.
Benefits your Members find
Mental health Cover goes unused because nobody can work out how to use it. Here it is checked and applied at the booking, without anyone having to call you.

The Benefit you can least see is the one they will actually use.

You receive everything adjudication needs. Holding more than that would only depress the utilisation you are already paying for.

Comes to you

Outcome trends
Aggregated, above a minimum group size
Utilisation and cost
What was used, and what it cost

We hold, so you do not

Who a Member is
Identity never travels with clinical data, so it never becomes yours to protect
What was said
Clinical Notes are not Claim evidence, and holding them would only add exposure

Start with one Benefit and a segment you choose.

Nobody adopts a network on a slide. Here is the smallest version that proves it.

01
Scope
Begin with one Benefit and a defined Member segment.
02
Run
Load the eligibility and adjudication rules, then run the agreed evidence path.
03
Decide
Compare Claim quality and access measures with the current baseline before expanding.

The questions you are about to ask.

Does this replace our adjudication system?: No. Claims arrive in your system, in your format, and your rules decide. Heyrafiki changes what a Claim looks like when it gets there, not who adjudicates it.
How do you handle a Member whose Cover runs out mid-course?: The check happens at every booking, not once at enrolment. When a Benefit is exhausted the next booking says so before it is made, and the Person is shown what they would pay instead of discovering it later.
Can we see clinical detail to justify a Claim?: You receive what adjudication needs: the coded Claim, the eligibility record, attendance, and confirmation that a named Practitioner approved the Note. The Notes themselves are not Claim evidence and do not cross to you.
Who is liable for the clinical decision?: The Practitioner, always. Iris drafts and suggests; nothing reaches a Record unless a named Practitioner approved it, and a Screening is never a Diagnosis.
What happens to our data if we leave?: The integration agreement defines the insurer-owned records, export format and transition process before production access opens.

A Benefit nobody can find is money spent on nothing.

Book a Demo Talk to us

Every Rejection is a question somebody failed to ask earlier.

So we ask all of them first. Here is one Claim, in the order the questions get answered.

#EventWhat was establishedWhen

01Eligibility checkedMember and Benefit confirmed against your rulesAt the booking
02Practitioner verifiedLicense checked against the Board that issued itAt the booking
03Session deliveredAttendance and duration recorded by the Room itselfThe hour
04Note approvedDrafted in the clinical format, approved by the PractitionerThe hour
05Claim assembledBuilt from the Session that produced it, not written up laterOn approval
06SubmittedStructured, complete, and already checked against 01Same day

Rows 01 and 02 preserve the eligibility and Practitioner evidence that row 06 depends on.

A typed adapter maps the Heyrafiki Claim to the agreed insurer format.

Reconciliation evidence stays beside each exchange.

FHIR
ICD-10
REST and OpenAPI
Webhooks

A Claim requires evidence from separate steps.

Eligibility, Practitioner standing, delivered Care and approved documentation keep their sources and times visible for fraud review.

Attendance keeps its source

Online Sessions can contribute system-recorded timing evidence; in-person attendance follows an explicit confirmation path with its source recorded.

The license was live

Checked against the issuing Board at the moment of booking, and re-checked on a standing schedule.

A named Practitioner approved it

Approval is recorded against a real, license-checked person, with the Client's consent captured before Iris drafted a line.

The Member was eligible first

Confirmed against your rules before the hour, so eligibility is never something asserted after the fact.

Each one is written by a different party, at a different moment, and none of them by the person being paid.

Three costs that stop being yours.

Measure avoidable rework

Checking eligibility and required evidence earlier removes avoidable rework before adjudication. Pilot evidence can measure return, resubmission and query rates against the insurer's baseline.

A network you can actually name

Every Practitioner is license-verified against the issuing Board, and re-checked. You know exactly who your Members are seeing.

Benefits your Members find

Mental health Cover goes unused because nobody can work out how to use it. Here it is checked and applied at the booking, without anyone having to call you.

The Benefit you can least see is the one they will actually use.

You receive everything adjudication needs. Holding more than that would only depress the utilisation you are already paying for.

Comes to you

Outcome trends
Aggregated, above a minimum group size
Utilisation and cost
What was used, and what it cost

We hold, so you do not

Who a Member is
Identity never travels with clinical data, so it never becomes yours to protect
What was said
Clinical Notes are not Claim evidence, and holding them would only add exposure

Start with one Benefit and a segment you choose.

Nobody adopts a network on a slide. Here is the smallest version that proves it.

Scope

Begin with one Benefit and a defined Member segment.

Run

Load the eligibility and adjudication rules, then run the agreed evidence path.

Decide

Compare Claim quality and access measures with the current baseline before expanding.

The questions you are about to ask.

Does this replace our adjudication system?

No. Claims arrive in your system, in your format, and your rules decide. Heyrafiki changes what a Claim looks like when it gets there, not who adjudicates it.

How do you handle a Member whose Cover runs out mid-course?

The check happens at every booking, not once at enrolment. When a Benefit is exhausted the next booking says so before it is made, and the Person is shown what they would pay instead of discovering it later.

Can we see clinical detail to justify a Claim?

You receive what adjudication needs: the coded Claim, the eligibility record, attendance, and confirmation that a named Practitioner approved the Note. The Notes themselves are not Claim evidence and do not cross to you.

Who is liable for the clinical decision?

The Practitioner, always. Iris drafts and suggests; nothing reaches a Record unless a named Practitioner approved it, and a Screening is never a Diagnosis.

What happens to our data if we leave?

The integration agreement defines the insurer-owned records, export format and transition process before production access opens.