Processes

What will AGI do for Adjudicate claims and process reimbursement?

A healthcare provider or policyholder submits a medical claim for services rendered.

Trigger: A healthcare provider or policyholder submits a medical claim for services rendered.
Outcome: The claim is resolved with funds routed to the designated payee and an Explanation of Benefits issued to the member.

The work itself

Grounded Work Profile

Ingest and validate the submitted electronic or paper claim dataprocessProfile
Verify member identity, active policy status, and specific coverage limitsprocessProfile
Review diagnostic and procedural codes for medical necessity and billing complianceprocessProfile
Calculate patient responsibility including deductibles, copayments, and coinsuranceprocessProfile
Determine the final reimbursement amount payable to the provider or memberprocessProfile
Disburse the payment and distribute the Explanation of Benefits and remittance adviceprocessProfile

How AGI delivers it

Services-as-Software
Get the professional outcome delivered as software, priced on results, not headcount.
Services.do
Autonomous Agents as digital employees
Hire a digital employee that does the job under earned, supervised autonomy.
Agents.do
Business-as-Code
Encode how your work runs, once, as software that executes itself.
Platform.do

Value flow

Go deeper