HEALTHCARE AGENTS · CLAIMS, DENIALS AND APPEALS
HOW IT WORKS
01
Start from the prebuilt agent
It already knows referrals, claims, remittances and fee schedules, and the checks your team runs on them.
02
Configure it to your tools, systems and parameters
We connect Epic or athenahealth, Availity, Waystar and your referral inbox, and load your contracts, standards and approval chain.
03
Release it into the work
It starts on live work. Our platform checks every draft against its source and stops where a person must approve.
04
It works like a trained member of your team
Work arrives ranked and drafted. Your team approves, and nothing reaches a patient or payer without sign-off.
OUR PLATFORM
Your contracts, standards, thresholds and approval chain, plus what your team knows, written down as the playbook the agent follows.
Every tool connected where it sits, one record per patient, and every figure traced to its source.
Every draft is checked against its source and your rules, and the agent stops where a person has to approve.
It sees only what the person it works for can see, your BAA obligations apply, and every step is logged.
THE SYSTEMS IT READS
Referrals, scheduling and encounters
Claim lines and expected reimbursement
Eligibility and prior authorisation
835 remittances and denial codes
Clearinghouse rejections
The fee schedule that was agreed
Referrals nobody triaged
Documentation supporting the charge
Cases, minutes and surgeon
Supplies consumed per case
One ledger per clinic
Older practice management extracts
FAQ
By reading the contract. The agent compares the signed fee schedule rate with what each remittance paid, and finds short payments on claims that were adjudicated and closed.
No. It comes prebuilt for payer contracts and remittances, and we configure it to your 835 remittances, payer agreements, claims register and denial log, including scanned contracts.
No. The agent drafts and prices each demand with the evidence attached, and the revenue cycle lead approves before anything goes out. It also tracks every contractual notice window.
Do we need a data team to run this?
No. We connect your systems, configure the agent to your rules and run the layer underneath it. Your team reviews and approves the agent’s work; nobody has to build or maintain data pipelines.
Do we have to move our data into a new warehouse first?
No. The agent works across the systems you already run, through a governed context layer that keeps every figure traced to the record it came from. If you already have a warehouse, it becomes one more source.
Why not build this ourselves?
You can, and for some teams it is the right call. The build is rarely the hard part. Resolving the same patient, payer and claim across systems, keeping definitions consistent and getting the team to use it every week is where internal projects stall. We take that on so your engineers do not become platform operators.
What are your security and compliance standards?
OutcomeCatalyst is HIPAA-aligned and SOC 2 Type 2 aligned, with the formal audit underway and expected to complete before year-end.
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