Unisound · Intelligent Healthcare Insurance Agent
Intelligent Healthcare Insurance , Precision Protection
Powered by the U2 Large Model and integrating NLP with clinical knowledge graphs, the solution delivers three core products—the DRG/DIP Payment Management Agent, Medical Insurance Settlement List Generation Agent, and Medical Insurance Fund Supervision Agent—to enable end-to-end intelligent transformation across medical insurance operations.
Industry Pain Points
Deep insight into healthcare insurance challenges, solved with AI
Fund Supervision Difficulties
Traditional insurance auditing relies on manual sampling — coverage under 10%, low efficiency and significant lag. Cannot perform real-time, end-to-end supervision over massive treatment activity, leaving fund safety blind spots.
Payment Management Challenges
Complex DRG/DIP rules and changing case groups make it difficult to detect grouping errors, coding issues, and cost risks, increasing compliance and financial risks.
Settlement List Preparation Pain Points
Medical insurance settlement lists require specialized expertise and involve a heavy workload. Manual preparation is inefficient and prone to omissions, coding errors, and inaccurate principal diagnosis selection, resulting in poor settlement quality, revenue loss, and compliance risks.
Core Products
Full-stack in-house product matrix covering the whole scenario chain
Core Advantages
Full-stack in-house technology, deep industry expertise
Top Medical LLM-Driven, Industry-leading Cognition
Powered by the "U2" healthcare-vertical LLM — repeated #1 in MedBench and other authoritative evaluations. Deep medical logical understanding and reasoning truly comprehend medical records, not just rule matching.
Authoritatively Validated Excellence
The DRG smart coding solution co-developed with Peking Union Medical College Hospital achieved 93.6% grouping accuracy — matching human expert coders and proven through top-tier medical institution practice.
Benchmark Large-scale Deployment
Built China's first provincial-level healthcare insurance LLM (Jiangsu), proving large-scale delivery and governance from single-hospital to regional-complex scenarios.
Featured Customers
Trusted by leading brands, proving solution value
Peking Union Medical College Hospital
To be addedUnisound’s Medical Insurance Settlement List Generation Agent has been officially deployed at Peking Union Medical College Hospital. Using AI to extract clinical information from electronic medical records, the Agent combines machine pre review with human verification to generate and validate compliant medical insurance settlement lists. It achieved 92% accuracy in principal diagnosis selection and 93.6% accuracy in case grouping, helping prevent claim denials caused by nonstandard coding and reducing penalty risk by more than 80%.
Jiangsu Healthcare Insurance Bureau
Unisound developed the Medical Insurance Fund Supervision Agent for the Jiangsu Provincial Healthcare Security Administration. Drawing on Unisound’s capabilities in medical NLP, large language models, and clinical record understanding, the Agent jointly analyzes clinical narratives, care pathways, pharmaceuticals, medical consumables, and insurance settlement data. Across DRG, DIP, and fee-for-service payment scenarios, it identifies inconsistencies between clinical activities and claims, then automatically produces supporting evidence and investigation leads for suspected violations. This helps reviewers quickly locate high-priority cases while improving the depth and quality of medical insurance fund supervision.
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