The RCM Agent routes each task to specialized Skills like Prior Auth and Appeals, with more on the way.
— The Agent orchestrates. Skills execute. —
Each skill is a specialized AI capability that plugs directly into your workflows. The Agent orchestrates. Skills execute.
Assesses every prior auth denial, identifies root cause instantly, and delivers a precise AI-recommended action plan. 45 minutes → under 5.
● ActiveAI-drafted, human-approved. Payer-specific appeal letters assembled in under 2 minutes. Every appeal requires analyst sign-off before it sends.
● ActiveIngests and applies coverage criteria from 300+ payer LCDs, NCDs, and proprietary policies in real time — with full citations.
● ActiveBuild your own RCM workflow agent with no-code templates. Define triggers, logic, actions — deploy in minutes, no engineering needed.
● ActiveThe Prior Auth RCM Agent assesses every prior authorization denial, identifies the root cause, and delivers a precise AI-recommended action plan — so your analysts spend their time executing, not investigating.
The Appeals Agent handles research, drafting, documentation assembly, and batch queuing — autonomously. Your analysts review every appeal before it goes out. Nothing leaves without explicit human sign-off.
AI generates appeal letters using denial reason codes, claim details, auth history, and clinical context — with payer-specific formatting applied automatically.
AI AutomatedRequired payer forms auto-populated from claim data. Analysts review a fully assembled package — no manual entry, no hunting for the right form.
AI AutomatedAppeal letter + payer forms + clinical documentation consolidated into a single file, ready for one-click upload to the payer portal.
AI AutomatedHigh-volume appeals batched and prioritized by filing deadline, payer, and denial amount. Analysts work in urgency order — no missed timely filing windows.
AI AutomatedEvery appeal is held in a review queue until an analyst explicitly approves it. Nothing is sent autonomously. Full compliance control stays with your team.
Human RequiredTracks which denial reason codes produce successful appeals — your team continuously improves quality and win rates over time.
AI AutomatedStop digging through 200-page policy documents. The Payer Policy Agent answers questions in plain English and returns accurate answers with citations from commercial payers, Medicare, and Medicaid — directly inside your RCM workflow.
Ask in plain English. Get accurate answers with citations from payer policies, LCDs, NCDs, and clinical guidelines — in under 5 seconds.
Never miss a payer policy change. Get instant alerts when payers update coverage criteria, auth requirements, or documentation rules that affect your claims volume.
Verify coverage criteria before billing. The agent checks diagnosis, CPT codes, and payer criteria together — surfacing exactly what documentation is needed.
Compare how Aetna, BCBS, UHC, and Humana handle the same procedure side by side — auth requirements, coverage thresholds, and documentation needs at a glance.
When a denial lands, the agent finds the exact policy language you need to win the appeal — cited, formatted, and ready to attach to your letter.
When you're working a denial in Denials 360, policy answers are one click away. No switching tabs. Policy citations auto-attach to your appeal.
Upload your documents. Get instant, accurate answers. Your team stops searching and starts doing — with a custom AI agent built on your SOPs, payer policies, and internal knowledge base.
Questions about the RCM Agent, Prior Auth Skill, and Appeals Skill — answered.