Revenue cycle management. Every claim checked, denials worked in time.
In healthcare, revenue leaks claim by claim: denials that were preventable at submission, underpayments below the audit threshold, prior auths that stall in a work queue.
We deploy RCM systems that check every claim against payer rules before it goes out, work denials while they’re still appealable, and reconcile remits against contracted rates — every file, not a sample.
Pre-submission scrubbing: every claim checked against payer rules before it leaves the building.
Denial workqueues ranked by appealability and value, worked while the appeal window is still open.
Remit reconciliation against contracted rates — every file, so underpayments below the old audit threshold stop slipping through.
The objects this use case reads and writes — stood up during the diagnostic, shared with every use case that follows.
parity with human adjusters, every-file claims auditing
Agentic claims auditing for a national insurance TPA — every file checked against policy terms and adjuster guidelines instead of a sample, catching overpayments and missed subrogation.
AI stopped
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