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AI Agent AI Agentic Claims Optimization System Active

Payer Rules Agent

Applies payer-specific billing policies using rule engine tools, validates LCD/NCD coverage requirements, checks prior authorization rules, monitors timely filing deadlines, and retrieves relevant payer policies from vector knowledge base..

View Core Logic Back to Worker
Parent Worker AI Agentic Claims Optimization System
Agent ID
payer-rules
Portal Nexgile-Sentinel Nexus
Sector Healthcare Technology & Revenue Cycle Management
Status
Operational

Problem Statement

The challenge addressed

Each payer has unique billing requirements, LCD/NCD policies, and authorization rules that must be applied accurately to avoid denials.

Core Logic

How the agent solves it

Applies payer-specific billing policies using rule engine tools, validates LCD/NCD coverage requirements, checks prior authorization rules, monitors timely filing deadlines, and retrieves relevant pay...

System Navigation

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Portal

Nexgile-Sentinel Nexus

Digital Worker

AI Agentic Claims Optimization System

Current Agent

Payer Rules Agent

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