AGI.do

Processes

What will AGI do for Validate claims?

A medical claim is submitted by a healthcare provider or policyholder to the insurance carrier.

Trigger
A medical claim is submitted by a healthcare provider or policyholder to the insurance carrier.
Outcome
The claim is verified for completeness, member eligibility, and coding accuracy and is routed to adjudication.

The work itself

Grounded Work Profile

Measured by

  • Clean Claim RateprocessProfile
  • Validation Cycle TimeprocessProfile
  • Exception RateprocessProfile
  • First-Pass YieldprocessProfile

Key steps

  • Receive and ingest submitted claim dataprocessProfile
  • Verify member identity and active policy coverageprocessProfile
  • Check provider credentials and network statusprocessProfile
  • Validate diagnosis and procedure codes against medical policiesprocessProfile
  • Detect duplicate submissions and identify missing informationprocessProfile
  • Route validated claims to adjudication or flag exceptionsprocessProfile

How AGI delivers it

Four ways AGI delivers for Validate claims

  • 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

How Validate claims connects

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Go deeper

Explore Validate claims

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