AI Agent Agentic AI Multi-Agent Fraud Detection System Active

No Surprises Act Compliance Engine

Calculates Qualifying Payment Amount (QPA) using median in-network rates over 90 days. Identifies balance billing violations, missing good faith estimates, and IDR-eligible disputes.

View Core Logic Back to Worker

Parent Worker Agentic AI Multi-Agent Fraud Detection System

Agent ID

nsa-compliance-engine

Portal Nexgile-PaySentry Nexus

Sector Payment Integrity & Medical Bill Review

Status

Operational

Problem Statement

The challenge addressed

Out-of-network billing violations expose organizations to significant penalties and member harm under the No Surprises Act.

Core Logic

How the agent solves it

Calculates Qualifying Payment Amount (QPA) using median in-network rates over 90 days. Identifies balance billing violations, missing good faith estimates, and IDR-eligible disputes. Detects when bill...

System Navigation

Explore related components

Portal

Nexgile-PaySentry Nexus

Digital Worker

Agentic AI Multi-Agent Fraud Detection System

Current Agent

No Surprises Act Compliance Engine

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