Enterprise AI Agentic Patient Financial Engagement Platform

Core Logic

Calculates patient propensity-to-pay scores using ML models with feature contributions from income, employment, payment history, and engagement metrics. Provides SHAP value explanations, confidence intervals, and counterfactual suggestions for score improvement.

Core Logic

Evaluates default probability with risk factor identification, calculates expected loss, identifies protective factors, and generates risk mitigation strategies with cost-benefit analysis and priority ranking.

Core Logic

Optimizes payment plans using constraint-based algorithms considering patient affordability, NPV maximization, and completion probability. Generates multiple plan alternatives with trade-off analysis and auto-pay incentives.

Core Logic

Analyzes historical engagement data to determine optimal communication channel (email, SMS, phone, portal, mail), best contact timing, and personalized message templates with expected open/response/conversion rates by channel.

Core Logic

Assesses five SDOH domains (economic stability, education access, healthcare access, neighborhood environment, social/community context), identifies applicable ICD-10 Z-codes, matches patients with community resources, and adjusts engagement strategies based on social factors.

Core Logic

Evaluates clinical justification and medical necessity scores, identifies required documentation and gaps, provides payer-specific approval probability estimates, generates recommended actions, and develops appeal strategies when needed.

Core Logic

Generates itemized Good Faith Estimates with provider and facility charges, validates compliance requirements, calculates patient responsibility, tracks estimate validity periods, and manages dispute rights documentation.

Core Logic

Generates personalized patient communications using GenAI with adjustable tone profiles (empathetic, professional, casual, urgent), reading level adjustment, multi-channel content adaptation, financial options explanations, and patient rights information.

Core Logic

Performs real-time eligibility verification with detailed benefit summaries, deductible tracking, out-of-pocket accumulator status, service-specific coverage details, and data freshness indicators.

Core Logic

Provides multi-level explanations (executive summary for CXOs, technical details for engineers, business context for BAs), SHAP value visualizations, decision tree breakdowns, model cards, demographic parity analysis, equalized odds metrics, disparate impact calculations, and calibration by group.

Core Logic

Enforces compliance guardrails for all regulations, performs content moderation, detects and masks PII, manages contact rate limits by channel, verifies consent status, and generates comprehensive audit trails with PHI access logging.

Core Logic

Synthesizes outputs from all agents into unified strategy recommendations (self-service, assisted, high-touch, hardship, collections), generates prioritized action plans, provides expected outcome projections including collection probability, time to resolution, patient satisfaction, and net recovery.