Claims Agent
Reads what the clinician documented, codes it, checks it against the payer's own rules before it is sent, and stops at the claims a person has to decide. Written for a regional healthcare system where the revenue cycle was losing to rework rather than to volume: 200,000 claims a month across 12 facilities, 72 out of every 100 paid first time, and the other 28 coming back to be done again. Six stations, run as a loop: what station 6 learns from a quarter of denials becomes the rule station 3 checks against.
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The workbench · subagents send notes, you make the human calls
SUBAGENTS AT WORK
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SUBAGENT NOTES
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YOUR TASKS · HUMAN IN THE LOOP
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YOUR TASKS · NONE AT THIS STEP
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Put a person back on this step
How to read this map
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A person is in the loop wherever a clinical judgement becomes a billing claim. Four of the six stations refuse to proceed on their own, Code Assigning, Claim Releasing, Denial Working and Payer Learning, and those are the four a person carries. Everywhere else the subagents run at volume and reach you only when they cannot settle something.
The loop closes
Station 6 does not end the quarter. A validation rule accepted after a denial read is the rule station 3 tests against, which is why the same denial stops arriving.