Back to 99th CentileDemo. All names, payers and figures are fictional sample data.

Review queue

Proposals from the agents that need a person's decision before anything is sent.
Billing lead
Awaiting review
8
$41,860 on hold
Cleared today
23
$118,240 moved forward

Proposals

Click a row to see the evidence
AgentProposalAmountConfidenceWaiting
Queue clear.Nothing waiting on a decision. Use Start over to run it again.

What the agents noticed

  • One payer drives most denialsGulfstream Health Plan rejects MRI claims without the prior-auth number in box 23. Two of today's proposals fix that.
  • Modifier 25 is under-usedSame-day injections with an E/M visit are billed without it in 6 of 40 sampled claims.
  • Underpayment patternCoastal Mutual pays screening colonoscopy below contract on outpatient claims since August.

Audit trail

Who decided what

    Under the hood

    How the full system is designed: specialist agents inside a harness that decides what they may touch, checks their work, and records everything.
    This page shows the design of the full system. The demo you just used simulates it with sample data; no live agents or payer connections run behind it.
    1 · Something happens
    Visit scheduledcheck coverage before the patient arrives
    Order placeddoes the payer need authorization?
    Claim denied or underpaidremittance comes back
    2 · The harness
    Routes the event to the right specialist, gives it only the tools it needs, and checks its work before a person ever sees it.
    ELEligibility
    PAPrior authorization
    CDCoding
    DNDenials
    PPPayment posting
    Add a specialist
    Least-privilege tools
    Done = rule checks pass
    Working record
    Model is swappable
    3 · A person decides
    Approval gateProposal plus evidence. Approve, edit, or reject with a reason.
    4 · Then it acts
    Sentto the payer or billing system
    Every step lands in one audit record: the event, the agent, the evidence, the checks, who approved, and what was sent.

    What each agent may touch

    No agent can send anything on its own
    AgentRead visit notesEligibility checkPayer rulesDraftSend
    Eligibilitynoyesyesyesafter approval
    Prior authorizationyesyesyesyesafter approval
    Codingyesnoyesyesafter approval
    Denialsyesnoyesyesafter approval
    Payment postingnonocontractsyesafter approval

    Checks before you see a proposal

    • The payer's own rule for that service is cited, not guessed.
    • Codes pass standard billing edits before they are proposed.
    • Amounts reconcile against the contract or the remittance.
    • Anything that does not add up is flagged, like the left versus right knee mismatch.

    What makes it different

    • The harness is the productModels change every few months. The rules, permissions, checks and records around them are what make the work safe to trust.
    • “Done” is checked, not claimedA proposal reaches you only after it passes rule checks outside the model's own opinion.
    • People stay in charge of what leaves the buildingAgents draft. A person approves. Fewer, better approvals instead of a pile of rubber stamps.
    • A record you can defendWho proposed what, on what evidence, who said yes, and what happened. Ready for an auditor or a payer dispute.
    • Built to plug in, not rip outWorks beside the practice-management system and clearinghouse already in place.