AI Agent Agentic AI Multi-Agent Fraud Detection System Active

Prior Authorization Automator

Implements FHIR Prior Authorization API with CRD/DTR integration. Validates PA existence, expiration status, and authorized units versus billed units.

View Core Logic Back to Worker

Parent Worker Agentic AI Multi-Agent Fraud Detection System

Agent ID

prior-auth-automator

Portal Nexgile-PaySentry Nexus

Sector Payment Integrity & Medical Bill Review

Status

Operational

Problem Statement

The challenge addressed

Manual prior authorization processes create delays and compliance risks as CMS 2026 mandates require electronic PA with real-time responses.

Core Logic

How the agent solves it

Implements FHIR Prior Authorization API with CRD/DTR integration. Validates PA existence, expiration status, and authorized units versus billed units. Calculates interoperability compliance scores aga... Implements FHIR Prior Authorization API with CRD/DTR integration. Validates PA existence, expiration status, and authorized units versus billed units. Calculates interoperability compliance scores against CMS 2026 requirements including electronic submission, real-time response, and patient access APIs.

System Navigation

Explore related components

Portal

Nexgile-PaySentry Nexus

Digital Worker

Agentic AI Multi-Agent Fraud Detection System

Current Agent

Prior Authorization Automator

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