Processes

What will AGI do for Perform referral management for members?

A primary care provider or member submits a request for a referral to a specialist or specialized medical service.

Trigger: A primary care provider or member submits a request for a referral to a specialist or specialized medical service.
Outcome: The referral request is adjudicated and recorded in the core system to govern future claims processing, and all parties are notified of the decision.

The work itself

Grounded Work Profile

Receive and log the referral request from the provider or memberprocessProfile
Verify member eligibility and active benefit plan rulesprocessProfile
Check provider network status to ensure the requested specialist is in-networkprocessProfile
Evaluate the request against clinical guidelines and administrative policiesprocessProfile
Issue an approval, modification, or denial for the referralprocessProfile
Transmit the referral decision to the requesting provider, receiving specialist, and memberprocessProfile
Update the core administrative system to link the authorized referral to future claimsprocessProfile

How AGI delivers it

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

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