Processes

What will AGI do for Validate clinical codes and documentation?

A medical claim containing clinical diagnosis and procedure codes is routed to the validation queue.

Trigger: A medical claim containing clinical diagnosis and procedure codes is routed to the validation queue.
Outcome: The submitted codes are verified as accurate, compliant, and medically supported, allowing the claim to proceed to financial adjudication.

The work itself

Grounded Work Profile

Extract diagnosis and procedure codes from the submitted claimprocessProfile
Screen codes against standard billing rules and policy coverage guidelinesprocessProfile
Request supporting clinical documentation from the provider if requiredprocessProfile
Compare the clinical documentation against submitted codes to confirm medical necessityprocessProfile
Flag instances of upcoding, unbundling, or unsupported servicesprocessProfile
Update the claim record with approved, modified, or denied clinical codesprocessProfile

How AGI delivers it

Services-as-Software
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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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