Claims compliance review agent

Why you need it

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Claim errors increase denial rates and slow reimbursement. Manual review takes time, especially when checking diagnosis codes, procedures, modifiers, and payer specific rules. This agent handles that review step automatically. It cross checks submitted claims against compliance rules, flags invalid coding or unbundling issues, identifies duplicates, and suggests adjustments or rejections with clear reasoning. This reduces rework, improves turnaround time, and increases clean claim rates.

What you need in Vellum

• Input for claim details including diagnosis, procedure, and modifier codes
• Reference rules or logic for payer compliance checks
• A step that detects invalid, duplicate, or unbundled codes
• Logic to generate recommended adjustments or rejection reasons
• Output formatting for clear summaries

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