Claim Denial Management Agent
Reads denial reasons, generates appeal letters with citations, and resubmits — closing the recovery loop.
RCMComplianceDocument AI
Claim Denial Management Agent
Polished agent demo — preview
Agent running
Agent thinking
- 1Reading inputs and pulling relevant context across systems…
- 2Building a plan: 4 steps, 2 tools, 1 human approval gate.
- 3Executing steps with progress streaming back to the user.
- 4Decision made. Drafting summary and queuing for review.
This demo is a polished preview. Book a build to see the production version.
The problem
Up to 9% of claims are denied on first submission. Manual appeal workflows recover only a fraction because staff prioritize high-dollar denials and let the rest age out.
What the agent does
- Classifies denial type (medical-necessity, coding, eligibility) from the EOB
- Drafts an appeal citing payer policy, clinical guidelines, and prior favorable rulings
- Tracks the appeal through to adjudication and learns from outcomes
Business value
Recovers 18% more revenue per denied claim and clears the appeal backlog within a single billing cycle.
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