Tag: Claims Processing
All the articles with the tag "Claims Processing".
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(ATCM) Considering Multi-Agents
The current Auth-to-Claim prototype successfully explains authorization and claim mismatches, but its reliance on human review highlights the need for a multi-agent approach capable of investigating and resolving exceptions at scale.
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(ATCM) New Project Foundation
A retrospective review of the Auth-to-Claim Reconciliation Engine prototype, outlining the deterministic matching foundation, exception-classification approach, and next steps toward incorporating AI agents to explain and investigate reconciliation failures.
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Auth-to-Claim Match (ATCM) Engineering Summaries
A healthcare modernization project evolved into a working agentic demonstration that combined deterministic reconciliation, investigative search, and AI-assisted reasoning to automate prior authorization–to–claim reconciliation while documenting the architectural decisions and learning process through an engineering build journal.