OpenSeva Payer App — Claims Processing

Standalone payer service · receives FHIR Claims · adjudicates via the Payment Integrity API · writes FHIR ClaimResponse
Simulation only — not real reimbursement logic. No real payer, clearinghouse, EDI, fee schedule, eligibility, or prior auth.

Claims (real-time)

Connecting…
ClaimPatientPayerStatusBilledPaidWellnessFraudPipeline

Insurances (sample payers)

PlanTypeCover%Copay

Pipeline

received → validate → eligibility / coverage → payment integrity (downcoding + fraud + payable amount, separate API) → adjudicate → write FHIR Claim + ClaimResponse.

In reality this is batch processing; here each stage is shown in real time. The EMR reads the same FHIR ClaimResponse to show live claim status.