Processes

What will AGI do for Communicate claim outcomes?

A health insurance claim completes the adjudication process with a final decision on coverage, payment, or denial.

Trigger: A health insurance claim completes the adjudication process with a final decision on coverage, payment, or denial.
Outcome: The member and healthcare provider receive formal, compliant notification of the claim decision, payment details, and any remaining financial responsibilities.

The work itself

Grounded Work Profile

Extract adjudicated claim data and coverage decisionsprocessProfile
Generate Explanation of Benefits (EOB) for the memberprocessProfile
Generate Electronic Remittance Advice (ERA) or paper remittance for the providerprocessProfile
Apply state and federal regulatory formatting requirementsprocessProfile
Dispatch communications via print, patient portal, or EDI channelsprocessProfile
Archive communication records for customer support and audit accessprocessProfile

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