For HMOs & insurers

Adjudicate, detect fraud and settle — at scale

Replace legacy claims software with an intelligent system of record: real-time eligibility, automated vetting, AI fraud scoring and one-click provider settlements.

Why HMOs choose Vetra

Run the whole operation in one place

Automated vetting

Rules, tariff and policy checks applied the moment a claim lands.

AI fraud intelligence

Catch duplicates, upcoding and anomalies before you pay.

Settlement engine

Batch, approve and pay providers, then auto-reconcile.

Instant eligibility

Verify members on the structured Member ID schema in milliseconds.

Approval controls

Role templates, approval limits and immutable audit logs.

Loss-ratio analytics

Utilization, leakage and latency in living dashboards.

Vetra Intelligence

AI that catches fraud before you pay for it

Every claim is scored the instant it arrives — surfacing duplicates, tariff breaches and anomalies with explainable confidence, so your team reviews what matters and approves the rest with certainty.

  • Duplicate & double billing
  • Tariff-breach & upcoding
  • Utilization anomalies
  • Eligibility & lapse risk

0.0B+

Exposure flagged

0%

Detection precision

0.0s

Avg. scan time

0%

Leakage reduced

“Duplicate claim suspected — CLM-24812 billed twice in 48h.”

Modernize your claims operation

See how leading HMOs run vetting, fraud and settlements on Vetra.