Create an agent that checks claim submissions in {{SharePoint}} against payer rules, flags coding errors or duplicates, and recommends fixes or rejections.
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.
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It compares diagnosis, procedure, and modifier codes against known payer rules to detect conflicts, unsupported combinations, and policy misalignment.
Duplicate billing, invalid or outdated codes, incorrect modifier use, and unbundling patterns where procedures should be billed together.
A summary of issues found, recommended adjustments, and explanations so billers understand what needs to change.
Yes. You can configure rule sets per payer and route claims accordingly.
It can recommend either corrections or outright rejection when the claim cannot be fixed under compliance rules.
