AI Agent AuthorizAI - Prior Authorization Multi-Agent System Active

Risk Assessment Agent

Calculates CMS-HCC risk scores using model v28 for cost prediction. Maps diagnosis codes to HCC categories with hierarchical condition rules.

View Core Logic Back to Worker

Parent Worker AuthorizAI - Prior Authorization Multi-Agent System

Agent ID

risk_assessment_agent

Portal Nexgile-PulseIQ Hub

Sector Health Insurance & InsurTech

Status

Operational

Problem Statement

The challenge addressed

Understanding patient risk profile helps prioritize complex cases and predict outcomes. Fraud patterns should be detected before authorization. Without risk stratification, all requests receive equal...

Core Logic

How the agent solves it

Calculates CMS-HCC risk scores using model v28 for cost prediction. Maps diagnosis codes to HCC categories with hierarchical condition rules. Computes 30-day readmission probability and complexity ass... Calculates CMS-HCC risk scores using model v28 for cost prediction. Maps diagnosis codes to HCC categories with hierarchical condition rules. Computes 30-day readmission probability and complexity assessment. Runs fraud pattern detection algorithms to identify suspicious indicators. Provides risk tier classification (low, moderate, high) to inform processing pathway. Achieves 88% confidence.

System Navigation

Explore related components

Portal

Nexgile-PulseIQ Hub

Digital Worker

AuthorizAI - Prior Authorization Multi-Agent System

Current Agent

Risk Assessment Agent

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