Your AI Agent Workforce for Claims Management

Meet your
Patient AccountsAccounts Receivable
Team

Claim Submission Agent

Automate the submission of clean claims to payers to save time, maximize reimbursement, and avoid timely filing denials.

EMR System
Patient:John Doe
CPT:99213
Date:12/15/24

Service Rendered

Scrubs and ensures clean claim

Agentic Process
Demographics ✓
Insurance ✓
Coding ✓
Modifier Added

Agent

Generate and send 837 to submit claim

Payer Portal
Format:X12 837
Status:Submitted
Time:2.3 sec

Payer

Claim Status Agent

Continuously receive timely updates on all claims, ensuring staff can act quickly to prevent denials and accelerate cash.

Claim Tracker
Claim ID:CLM-2024-001
Amount:$245.00
Status:Pending

Claim Submitted

Continuous monitoring every 15 minutes

Agentic Process
Checking payer portal
24/7 Active
Last check: 2 min ago

Agent Monitors

Real-time updates to EMR and staff alerts

Staff Notifications
Claim Paid
EMR Updated
Team Notified

Updates & Alerts

Automated Appeals Assistant

Our assistant works alongside staff to generate appeals and automate submission with human-in-the-loop. Over time, custom agents get generated to automate work completely.

Denial Notice
Reason:Medical Necessity
Code:CO-50
Amount:$245.00

Denial Received

AI analyzes denial reason and medical records

Agentic Process
Chart reviewed
Guidelines checked
Appeal drafted

AI Analysis

Staff reviews and approves AI work

Appeal Submission
Status:Submitted
Method:Portal + Fax
Time:4.2 min

Appeal Submitted

Trained Appeals Agents

Custom agents generated from your assistant's work to fully automate specific workflows

Cardiology Appeals
CPT Codes:93000-93799
Payer:Aetna
Plan:Better Health
NPI:1234567890
Orthopedic Appeals
CPT Codes:20000-29999
Payer:BCBS
Plan:PPO Plus
NPI:0987654321
Radiology Appeals
CPT Codes:70000-79999
Payer:UnitedHealthcare
Plan:Choice Plus
NPI:1122334455
Emergency Dept
CPT Codes:99281-99285
Payer:Medicare
Plan:Advantage
NPI:5566778899

Ready to Transform Your Claims Process?

See how our AI agents and assistants can reduce denials, automate appeals, and increase your revenue recovery.