AI Agent Shield Litigation Risk Prediction System Active

Prior Authorization Intelligence Agent

View Core Logic Back to Worker

Parent Worker Shield Litigation Risk Prediction System

Agent ID

prior-auth-intelligence

Portal Nexgile-PaySentry Nexus

Sector Payment Integrity & Medical Bill Review

Status

Operational

Problem Statement

The challenge addressed

CMS 2026 mandates require electronic prior authorization with specific interoperability requirements that affect claim validity and defense strategies.

Core Logic

How the agent solves it

Performs FHIR compliance verification, real-time PA status checking, and denial pattern analysis using GPT-4-Turbo with FHIR parser. Validates CMS 2026 compliance across electronic submission, real-ti... Performs FHIR compliance verification, real-time PA status checking, and denial pattern analysis using GPT-4-Turbo with FHIR parser. Validates CMS 2026 compliance across electronic submission, real-time response, patient access API, and provider directory API requirements. Generates interoperability scores and appeal recommendations.

System Navigation

Explore related components

Portal

Nexgile-PaySentry Nexus

Digital Worker

Shield Litigation Risk Prediction System

Current Agent

Prior Authorization Intelligence Agent

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