README.md

---
title: ClaimReady — Claim Submission Check
emoji: 🏥
colorFrom: blue
colorTo: green
sdk: gradio
app_file: app.py
pinned: false
short_description: Catch claim errors before you submit — open model
tags:
  - build-small-hackathon
  - document-ai
  - vision-language
  - multilingual
  - healthcare
  - track:backyard
  - achievement:offgrid
  - achievement:offbrand
---

# 🏥 ClaimReady

**An assistive pre-check for hospital health-insurance claims — built for hospital administration
staff.** ClaimReady helps hospitals **identify potential compliance issues before submitting claim
documents to insurance providers**. It analyses uploaded documents against package-specific
treatment guidelines and provides **actionable feedback on missing, incomplete, or non-compliant
documents**, allowing hospitals to correct issues early in the process.

It runs **entirely inside the Space on a small open model — Gemma 3 12B (≤ 32B)** — with **no cloud
inference API**.

## 🎥 Demo & Links

- **▶️ Demo video:** https://youtu.be/A4PCHp89bsQ
- **📣 Social post:** https://www.linkedin.com/posts/ullivinaybabu_build-huggingface-gradio-share-7472141735138119681-80Th/
- **💻 Source code (GitHub):** https://github.com/vinayulli/claim_ready
- **🚀 Live app:** this Space — open the **"Load a sample claim"** buttons at the top to try it in one tap.

## 📋 Overview

ClaimReady is used by **hospital administration / billing staff**. For this prototype it uses the
**PMJAY (Pradhan Mantri Jan Arogya Yojana)** scheme as an example, where hospitals must follow
**Standard Treatment Guidelines (STGs)** when submitting claims. Because these guidelines vary
across treatment packages, the application evaluates each claim against the **selected package's
requirements**.

The goal is simple: **reduce claim rejections, minimise processing delays, and improve operational
efficiency** for hospitals and claim teams.

## 🚩 Problem Statement

Health-insurance claims — for example under India's **Ayushman Bharat / PMJAY** scheme — require a
specific set of **supporting documents** that must satisfy the applicable **clinical / treatment
guidelines** for each procedure and stage (pre-authorization / claim).

- Every claim must include **all mandatory documents** and meet defined **content conditions** for the procedure and stage.
- A missing document — or a value that doesn't meet a condition — can lead to **claim rejection**, delays and rework.

## ✅ Solution — What ClaimReady Offers

- 📄 Reads every uploaded document with **on-device OCR** — images *and* PDFs.
- ✅ Verifies the set against the **required-document checklist** for the selected package and stage.
- 🔎 Evaluates **content rules** (thresholds, conditions) against the values it *actually reads*.
- 🌐 Handles **mixed-language** documents — e.g. **English + Hindi / Telugu** in the same record.
- 🖼️ Built-in **document viewer** — preview every page (images and PDF pages) before checking.
- ⚠️ Surfaces **missing, incomplete, or non-compliant documents early**, with supporting evidence — as an **assistive** pre-check.

## 🔧 How It Works

1. **Select a package + stage** → the app loads the required-document checklist and content rules (data-driven from `packages.json`).
2. **Upload documents (or click a sample)** → PDFs and images are rendered to page images (PyMuPDF) and shown in the viewer.
3. **Run the check** → the document images + the checklist + a strict review prompt go to **Gemma 3 12B**, which **OCRs and reasons in a single pass** and returns structured JSON.
4. **Review** → rendered as a clear **✅ / ❌ / ⚠️** assistive review with evidence and an action list. (Low-confidence "present" documents are flagged as gaps, to stay conservative.)

## 📈 Scope & Scalability

- Currently supports **four treatment packages** as a proof of concept.
- The logic is **data-driven** (`packages.json`), so the architecture is **scalable** and can easily
  be extended to support many more **packages, insurance providers, and compliance frameworks**.

## 🧱 Built Small

| | |
|---|---|
| **Model** | `google/gemma-3-12b-it` — a small, open **≤ 32B** model |
| **Runtime** | Hugging Face **Transformers on ZeroGPU** — runs inside the Space, **no external / cloud inference API** |
| **Stack** | Gradio · PyMuPDF · Pillow · 🤗 Transformers |

## 🩺 Note

ClaimReady is a **decision-support** tool — it highlights likely gaps for review and does **not**
approve or reject claims. The sample claims in the app are **synthetic** (fictional patients) —
**no real patient data**.

---

*Built by [**@vinaybabu**](https://huggingface.co/vinaybabu) for the **HuggingFace Build Small Hackathon** · Backyard AI track.*