| --- |
| 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.* |
|
|
