Processes

What will AGI do for Prepare and process claims?

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 fully adjudicated and resolved, resulting in a scheduled payment and a generated Explanation of Benefits, or a formal denial.

The work itself

Grounded Work Profile

Receive and digitize incoming EDI or paper claim submissionsprocessProfile
Verify patient eligibility and active policy coverage for the date of serviceprocessProfile
Validate medical codes against billing rules and contracted fee schedulesprocessProfile
Adjudicate the claim to calculate payer liability and patient responsibilityprocessProfile
Route complex or flagged claims for manual administrative or clinical reviewprocessProfile
Generate the Explanation of Benefits and issue payment to the provider or memberprocessProfile

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

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