Define the claim type and payer
Start with one bounded outpatient workflow.
HOW IT WORKS
From imported claim to a documented human action.
Burhaneo organizes a review process around the issue, the source and what a claims specialist should investigate next.
01
Bring in claim data
Import claims and text-bearing clinical evidence. Authorized, secure data pipelines are needed for real patient records.
02
Run configured checks
Evaluate selected fields and supporting evidence against approved rules where available.
03
Review findings
Inspect the rule reference, cited source passage and any uncertainty or missing information.
04
Record a decision
Ask for documents, refer a clinical question, document corrections or record internal review.
On-screen example
Show the evidence behind the flag.
Instead of an unsupported red warning or rejection probability, an example review shows a possible authorization-reference gap, then a treatment-history passage with an illustrative clinical criterion.
This is not a live payer decision. The illustrative rule is not asserted to be a Saudi insurer policy.
Ready for a controlled pilot
An evaluation, not a guess.
Before using the workflow in live hospital operations, rules and proposed actions should be compared with independently annotated historical claims in a security-approved environment.
Agree on expected findings
Clinical and RCM experts create the validation labels.
Measure outcomes
Review missed issues, false positives, source quality and reviewer usefulness.