Coding & Billing Agent: Maximize Reimbursement
Automatically assigns ICD-10 diagnosis codes, CPT procedure codes, and modifiers based on clinical documentation—then generates and submits claims to payers.
Key Capabilities
- Auto-Coding - Analyzes SOAP notes, suggests appropriate codes
- Compliance Checking - Ensures medical necessity, correct modifiers, bundling rules
- Claim Generation - Creates 837 EDI transactions for electronic submission
- Scrubbing - Pre-submission validation to catch errors before payer rejection
- Batch Submission - Sends claims to clearinghouse or payer daily
- Charge Capture - Ensures all billable services are coded and billed
- Payer Rules Engine - Applies payer-specific coding requirements
- Real-Time Eligibility - Checks insurance eligibility before submission
Impact
Clean Claim Rate
99%
Staff Reduction
50-75%
Submission Speed
Same-day
Revenue Increase
+15%
Technical Details
Integration & Features
- Code Libraries
- CPT, ICD-10, HCPCS current codes
- Integration
- EHR clinical documentation and practice management
- Standards
- 837 EDI transaction creation
- Rules Engine
- Payer-specific coding requirements
Security & Compliance
- HIPAA Compliant
- SOC 2 Type II Certified
- Real-time processing and logging
- End-to-end encryption
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