Glossary
Healthcare AI & revenue cycle glossary
The terms that come up when practices move administrative work to AI agents — defined plainly, without the hype. From agentic AI and the aPMS category to the revenue cycle steps agents run every day.
Autonomous healthcare AI
Autonomous Practice Management System (aPMS)
An Autonomous Practice Management System (aPMS) is a category of healthcare software in which AI agents execute administrative work end-to-end — answering calls, processing claims, handling prior authorizations — instead of queuing tasks for staff to complete by hand. Where a traditional practice management system stores and organizes information, an aPMS acts on it autonomously. Caesar Health is built as an aPMS that runs alongside a practice’s existing EMR.
AI agent (in healthcare)
A healthcare AI agent is autonomous software that completes a defined administrative job — answering patient calls, submitting prior authorizations, posting payments — from start to finish, making decisions and writing results back to the EMR without step-by-step human direction. Agents differ from chatbots or assistants, which respond to prompts but do not carry the work to completion.
See the AI agents →Agentic AI
Agentic AI refers to AI systems that pursue a goal across multiple steps — planning, taking actions, using tools, and adapting to what they find — rather than producing a single response. In healthcare administration, agentic AI is what lets an agent work a claim through eligibility, submission, and follow-up on its own.
EMR integration layer
The EMR integration layer is the connective software that lets AI agents read from and write to an electronic medical record system such as Epic, athenahealth, or eClinicalWorks. It is what allows agents to work inside a practice’s existing systems without ripping out or replacing the EMR.
How EMR integration works →
Revenue cycle
Revenue cycle management (RCM)
Revenue cycle management (RCM) is the end-to-end financial process a practice uses to get paid — from insurance eligibility and prior authorization through coding, claim submission, denial management, and payment posting. A breakdown anywhere in the cycle delays or loses revenue.
Revenue Cycle agents →Denial management
A claim denial is a payer’s refusal to reimburse a submitted claim; denial management is the work of finding why, correcting the claim, and resubmitting or appealing it. Because reworking denials is labor-intensive, practices often write off denied claims that could have been recovered.
Denial Management agent →Payment posting
Payment posting is the step where payments from insurers and patients are recorded against the correct claims and accounts, including adjustments and remittance detail. Accurate posting is what surfaces the underpayments and denials that would otherwise go unnoticed.
Payment Posting agent →Eligibility verification
Eligibility verification is confirming a patient’s active insurance coverage and benefits before a visit or service. Verifying eligibility up front prevents a large share of downstream claim denials.
Clinical & patient
AI medical scribe (ambient documentation)
An AI medical scribe generates clinical documentation from a patient encounter — typically by listening to the visit (ambient documentation) and drafting the note for the clinician to review and sign. It reduces after-hours charting so clinicians spend less time in the record and more with patients.
AI Scribe →Patient intake
Patient intake is the process of collecting a patient’s demographic, insurance, and clinical information before or at the start of a visit. Automating intake reduces front-desk workload and the data errors that later cause claim rejections.
Patient Intake agent →Care gap
A care gap is the difference between the care a patient should receive under clinical guidelines and the care they have actually received — for example, an overdue screening or an unaddressed chronic-condition follow-up. Closing care gaps is central to quality performance and value-based care.
Care Gap agent →
Payment models & compliance
Value-based care (VBC)
Value-based care (VBC) is a payment model in which providers are reimbursed based on patient outcomes and quality rather than the volume of services delivered. It shifts financial risk toward providers and ties administrative accuracy — documentation, coding, care-gap closure — directly to revenue.
Value-based care solutions →HIPAA compliance
HIPAA — the Health Insurance Portability and Accountability Act — sets U.S. requirements for protecting patients’ health information. HIPAA-compliant software enforces safeguards for how protected health information (PHI) is stored, transmitted, and accessed.
Business Associate Agreement (BAA)
A Business Associate Agreement (BAA) is a HIPAA-required contract between a healthcare provider and a vendor that handles protected health information on its behalf, defining how that data may be used and safeguarded. Caesar Health executes a BAA at contract signing.