AI-Powered · Human-in-the-Loop · Multi-Agent

Agentic AI Claim Resolution Expert

Automating A/R denial workflows for U.S. healthcare providers

⚠️

Problem

Large U.S. healthcare providers deploy large teams for A/R followups—payer calls, portal checks & documentation, claim status checks etc. This accounts for ~15-20% of total RCM opex, resulting in:

Delayed collections
Higher cost-to-collect
Inconsistent denial resolution

✅

Solution

A multi-agentic system automating the manual denial processing workflows can:

Expedite collections
Reduce A/R days
Reduce labor costs
Reduce human errors
Generate longitudinal claim resolution data for further analysis
Reduces denial backlog

🤖

Current Implementation

Uses AI agents to automate A/R followup workflows with human-in-the-loop:

🔍 RCA Agent

Retrieves claim denial info from EHR/PMS, analyses it and retrieves payer-specific denial resolution steps from SOPs. Takes human approval before proceeding.

⚡ NBA Agent

Executes those steps and takes human approval before submitting final case notes back to EHR/PMS.

Note: Currently 2 claim IDs (12345, 33003) are processed in an automated fashion with human-in-the-loop checkpoints. Enter claim ID 12345 to start the workflow.

Claim Input

Enter claim ID

RCA Analysis

Root cause analysis

Human Review

Approve intelligence summary

Draft Appeal

Retrieve docs & draft letter

Appeal Review

Approve drafted letter

Submit Appeal

Submit to payer portal

Case Review

Approve final case notes

Complete

Provider DB updated

Process a Claim

Enter a Claim Record ID to start the AI-powered denial resolution pipeline.

Claim Record ID