AGI.do

Services

What will AGI do for Medical Claims Review and Management?

Positioning for this Coordinate is coming soon.

The work itself

Grounded Work Profile

Tools

  • Claims Intake PortalserviceBlueprint
  • Claims Adjudication SystemserviceBlueprint
  • Medical Review WorkbenchserviceBlueprint
  • Payer Reporting PortalserviceBlueprint
  • Case Management SystemserviceBlueprint

Outputs

  • Claims Determination RecordsserviceBlueprint
  • Medical Review FindingsserviceBlueprint
  • Appeals Case FileserviceBlueprint

Measured by

  • Claims AccuracyserviceBlueprint
  • Turnaround TimeserviceBlueprint

Key steps

  • Receive Submitted ClaimsserviceBlueprint
  • Validate Coding And EligibilityserviceBlueprint
  • Conduct Clinical Medical ReviewserviceBlueprint
  • Determine Payment Or DenialserviceBlueprint
  • Issue Determination To PayerserviceBlueprint
  • Manage Appeals And AuditsserviceBlueprint

How AGI delivers it

Four ways AGI delivers for Medical Claims Review and Management

  • 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

Value flow

How Medical Claims Review and Management connects

absorbs

composes

measured by

  • Adjudication Accuracymodel
  • Turnaround Timemodel

optimizes

  • Claims Accuracymodel
  • Denial Overturn Ratemodel
  • Turnaround Timemodel

produces

  • Appeals Case Filemodel
  • Claims Determination Recordsmodel
  • Medical Review Findingsmodel

realizes

  • Conduct Clinical Medical Reviewmodel
  • Determine Payment Or Denialmodel
  • Issue Determination To Payermodel
  • Manage Appeals And Auditsmodel
  • Receive Submitted Claimsmodel
  • Validate Coding And Eligibilitymodel

Go deeper

Explore Medical Claims Review and Management

Read the deeper take on agi.asView as markdown