End-to-End Agentic AI for Billing
Nine interoperable agents that automate the revenue cycle.
Billing Automation
Our agent fully automates routine billing workflows, from charge capture and coding validation to payment posting, eliminating manual tasks and accelerating claims.
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- Inputs: EDI 837, charge master data, clinical notes
- Outputs: Clean claims, payment posts, workflow reports
- Integrations: EHR, Practice Management Systems
- KPIs: Clean claim rate, days to bill, staff productivity
Insurance Interactions (Voice + API)
Our voice-enabled agent navigates IVRs, handles benefit calls, and retrieves authorizations 24/7, so your staff never wait on hold again.
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- Inputs: Call audio, IVR prompts, member data
- Outputs: Authorization codes, call notes, benefit summaries
- Integrations: Voice, API, Payer Portals
- KPIs: Call deflection rate, hold time reduction
Eligibility & Benefits Verification
Real-time AI-driven checks confirm coverage, benefits, and copays before services are rendered, reducing rejections and billing disputes.
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- Inputs: EDI 270/271, patient demographics
- Outputs: Eligibility status, copay/deductible info
- Integrations: Clearinghouse, Payer Portals
- KPIs: Eligibility-related denial rate, POS collections
Denial Management & Re-Submissions
Our agent flags errors instantly, auto-corrects claims based on historical data, and resubmits within minutes to recover revenue faster.
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- Inputs: EDI 835, denial reason codes
- Outputs: Corrected claims, appeal packets
- Integrations: Clearinghouse, Payer Portals
- KPIs: Denial rate, days to resolve, rework reduction
Patient Billing Support
Friendly patient-facing AI agents assist with statements, disputes, and flexible payment plans, improving satisfaction and accelerating collections.
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- Inputs: Patient queries (chat/voice), billing data
- Outputs: Payment plan setup, dispute resolution
- Integrations: Patient Portal, Payment Gateway
- KPIs: Patient satisfaction, cost-to-collect
Revenue Cycle Optimization
With a full-cycle view, agents analyze workflows, detect bottlenecks, and recommend actions that increase cash flow and shorten AR days.
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- Inputs: RCM-wide performance data
- Outputs: Process improvement recommendations
- Integrations: Analytics dashboard
- KPIs: Days Sales Outstanding (DSO), net collection rate
Fraud Detection & Prevention
AI models continuously scan transactions for anomalies and suspicious patterns, reducing fraud exposure while staying audit-ready.
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- Inputs: Claims data, billing patterns
- Outputs: Anomaly alerts, audit trails
- Integrations: Compliance software
- KPIs: Fraud-related write-offs, audit success rate
Patient Care Optimization Agents
By identifying care gaps and connecting patients to follow-up care, agents help improve clinical outcomes while ensuring billing aligns with care delivery.
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- Inputs: Clinical data, patient history
- Outputs: Care gap alerts, patient outreach
- Integrations: EHR, Care Management platforms
- KPIs: Care gap closure rate, patient retention
Automated Care Management Follow-Ups
Agents automatically reach out after visits, ensuring medication adherence, scheduling follow-ups, and closing the loop between care and billing.
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- Inputs: Discharge summaries, care plans
- Outputs: Automated patient calls/texts, scheduled appointments
- Integrations: EHR, scheduling systems
- KPIs: Readmission rates, medication adherence