AI Agent Agentic AI Multi-Agent Fraud Detection System Active

Real-Time Eligibility Verifier

Performs real-time X12 270/271 transactions combined with FHIR R4 Coverage queries. Detects COB situations, terminated coverage, dependent age-outs, and Medicare/Medicaid dual eligibility.

View Core Logic Back to Worker

Parent Worker Agentic AI Multi-Agent Fraud Detection System

Agent ID

eligibility-verifier

Portal Nexgile-PaySentry Nexus

Sector Payment Integrity & Medical Bill Review

Status

Operational

Problem Statement

The challenge addressed

Claims processing without real-time eligibility verification leads to payment of ineligible claims and coordination of benefits failures.

Core Logic

How the agent solves it

Performs real-time X12 270/271 transactions combined with FHIR R4 Coverage queries. Detects COB situations, terminated coverage, dependent age-outs, and Medicare/Medicaid dual eligibility. Validates c...

System Navigation

Explore related components

Portal

Nexgile-PaySentry Nexus

Digital Worker

Agentic AI Multi-Agent Fraud Detection System

Current Agent

Real-Time Eligibility Verifier

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