Denial Agent
Every denial has a story. The Denial Agent reads the 835 remittance, classifies the denial reason, identifies the root cause, and queues the right corrective action — whether that's a code correction, eligibility re-verification, or an appeal. It also spots trends across payers so you can fix systemic issues, not just individual claims.
How It Works
Four steps from setup to results — no IT project required.
Parse remittances
The agent automatically ingests 835 electronic remittance advice files and identifies denied claims with their reason codes.
Classify and diagnose
Each denial is classified by root cause — coding error, eligibility issue, medical necessity, duplicate, timing — and the agent determines what corrective action is needed.
Route to resolution
Denials are routed to the right workflow: code correction back to the Coding Agent, eligibility re-check to the Eligibility Agent, or appeal to the Appeals Agent.
Surface trends
The agent tracks denial patterns across payers, providers, and categories — so you can address systemic issues like a payer policy change or a recurring coding error.
What It Does
Every capability included, out of the box.
Common Use Cases
Works With Your Stack
Frequently Asked Questions
Real questions from practices evaluating this agent.
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