What is an AI Agent?
An AI Agent is an intelligent software system that can autonomously perform tasks, make decisions, and take actions on behalf of users or organizations. Unlike traditional software that simply follows predetermined rules, AI Agents use artificial intelligence to understand context, learn from data, and adapt their behavior to achieve specific goals.
Key Characteristics:
- Autonomy: AI Agents work independently with minimal human intervention, making decisions and executing tasks based on their training and objectives
- Intelligence: They use machine learning and natural language processing to understand complex information, identify patterns, and make informed decisions
- Goal-oriented: Each agent is designed with specific objectives, whether that's verifying insurance eligibility, processing claims, or managing accounts receivable
- Continuous operation: AI Agents can work 24/7, handling tasks at scale without fatigue or errors from repetition
- Learning capability: They improve over time by learning from outcomes and feedback, becoming more accurate and efficient
In Healthcare Revenue Cycle:
AI Agents transform revenue cycle management by automating complex, time-consuming processes that traditionally required extensive manual work. Each agent specializes in a specific domain—like SAGE for eligibility verification or ATLAS for claims processing—bringing expert-level performance to routine tasks while freeing staff to focus on exceptions and patient care.
Specialized Workflow Expertise:
Our AI agents are purpose-built for healthcare revenue cycle management, with each agent specializing in a specific workflow domain. Unlike general-purpose automation tools, every agent is trained on millions of healthcare transactions and deeply understands the nuances of medical billing, payer requirements, and regulatory compliance.
Domain Specialization:
- Pre-Service Revenue Protection (SAGE): Specializes in insurance eligibility verification workflows, understanding the intricacies of payer portals, benefit structures, and coverage determination logic
- Claims Management (ATLAS): Expert in medical coding workflows, translating clinical documentation into properly coded claims while applying payer-specific billing rules and compliance requirements
- Denial Management (ARIA): Focused on appeals workflows, analyzing denial reasons, assembling medical necessity documentation, and crafting payer-specific appeal arguments
- Collections & A/R (Zephyr): Specializes in accounts receivable workflows, predicting payment likelihood, prioritizing collection efforts, and orchestrating follow-up sequences
- Payment Posting (PACE): Expert in reconciliation workflows, interpreting ERAs, processing EOBs, matching payments to claims, and identifying posting errors
- Audit Prevention (Kulshan): Specialized in compliance workflows, monitoring for audit triggers, validating documentation completeness, and identifying billing patterns that raise flags
This specialization ensures each agent delivers expert-level performance in its domain, understanding workflow-specific rules, exceptions, and best practices that general automation simply cannot match.
Stop losing money to coverage surprises
Smart Automated Gateway for Eligibility - Real-time eligibility and benefits verification before every appointment
Key Features:
- Real-time verification
- Benefit breakdowns
- Pre-visit alerts
- Coverage gap detection
Prevent $15K+ in denied claims monthly
Free your team from hours of claim building and submission
End-to-end claim automation - AI translates encounters into properly coded claims, scrubs for errors, and submits directly to clearinghouses
Key Features:
- Automated claim generation
- CPT/ICD-10 coding
- Pre-submission scrubbing
- Direct clearinghouse submission
Eliminate 15+ hours per week of claim work
Turn rejections into revenue
Automated Revenue Intelligence Assistant - Automated denial appeals with proper documentation and medical necessity
Key Features:
- Denial analysis
- Automated appeals
- Medical necessity docs
- Tracking & follow-up
Recover 30% more from denied claims
Spot the accounts costing you money
AI-powered A/R prioritization and automated follow-up sequences
Key Features:
- Predictive analytics
- Automated sequencing
- Smart prioritization
- Patient communication
Reduce A/R aging by 20 days average
End manual payment posting forever
Automated posting and reconciliation for all payment types
Key Features:
- ERA auto-posting
- Check processing
- Patient payments
- Reconciliation reports
Save 15+ hours per week on posting
Protect your revenue from surprise takebacks
Proactive audit monitoring and compliance documentation
Key Features:
- Audit monitoring
- Compliance checks
- Documentation alerts
- Risk assessment
Prevent zero surprise clawbacks
Credential Management & Multi-Account Organization
Our platform allows you to link specific credentials to individual accounts, giving you complete control over how you manage multiple customers, facilities, or revenue cycle operations.
Account-Specific Credentials:
- Each account in your workspace can have its own set of credentials for payer portals, clearinghouses, and other integrations
- Credentials are securely stored and associated with specific accounts, ensuring proper access control and audit trails
- You can manage different TINs, NPIs, and provider identifiers for each account or location
- Update or rotate credentials at the account level without affecting other accounts in your organization
Multi-Account Reporting & Organization:
- View consolidated reporting across all accounts or drill down into specific account performance
- Track key metrics (claim acceptance rates, denial rates, A/R aging, collection rates) by individual account
- Compare performance across multiple customers or facilities to identify best practices and improvement opportunities
- Filter and segment data by account, making it easy to generate customer-specific reports or invoices
- Set up account-specific workflows and rules that align with each customer's unique requirements
Perfect for:
- Medical Billing Companies: Manage credentials and reporting separately for each client practice
- Multi-Location Practices: Track performance across different offices or facilities
- Healthcare Systems: Organize by department, specialty, or facility while maintaining centralized oversight
- RCM Service Providers: Deliver transparent, account-specific reporting to each customer
This account-based architecture ensures that each customer's data, credentials, and performance metrics remain completely separate while giving you the flexibility to view consolidated analytics when needed.
Frequently Asked Questions
How do AI Agents differ from traditional automation?
Traditional automation follows rigid, pre-programmed rules and breaks when it encounters exceptions. AI Agents use machine learning to understand context, adapt to variations, and handle edge cases intelligently. They learn from outcomes and improve over time, making them far more robust for complex healthcare workflows.
How long does it take to implement AI Agents?
Most organizations see their first agents running within 2-4 weeks. Implementation time varies by agent type and complexity of existing systems, but our team handles the heavy lifting of integration, credential setup, and initial training.
Do AI Agents replace my revenue cycle staff?
No. AI Agents handle repetitive, high-volume tasks so your staff can focus on complex cases, patient interactions, and strategic work. Most organizations redeploy staff to higher-value activities rather than reducing headcount, resulting in better outcomes and higher job satisfaction.
How secure are my credentials and patient data?
All credentials are encrypted at rest and in transit using industry-standard encryption. Patient data is processed in HIPAA-compliant infrastructure with strict access controls. Each account's credentials and data are completely isolated, and we never share data across accounts or organizations.
Can I use AI Agents for multiple locations or clients?
Yes. Our multi-account architecture allows you to manage separate credentials, workflows, and reporting for each location or client. This is ideal for billing companies managing multiple practices, healthcare systems with multiple facilities, or RCM providers serving various customers.
What happens if an AI Agent makes a mistake?
All agent actions are logged and auditable. For critical workflows like claim submission, agents include quality checks and validation steps. You can configure approval workflows for specific action types, and our monitoring systems alert you to anomalies. Agents also learn from corrections to prevent similar errors.
How much ROI can I expect from AI Agents?
ROI varies by organization size and current efficiency, but typical outcomes include: 15-20% reduction in claim denials, 20-30 day reduction in A/R aging, 15+ hours saved per week per agent, and 30%+ improvement in denied claim recovery rates. Most organizations see positive ROI within 3-6 months.
Do AI Agents work with my existing practice management system?
Our agents integrate with most major PM/EHR systems including Epic, Athenahealth, eClinicalWorks, NextGen, and others. We also work with major clearinghouses and payer portals. Our implementation team will assess your specific tech stack during onboarding.
Can I customize how AI Agents work?
Yes. While agents come with best-practice configurations, you can customize workflows, approval thresholds, prioritization rules, and communication templates to match your organization's preferences and requirements.
What kind of reporting and visibility do I get?
You receive detailed dashboards showing agent performance, productivity metrics, financial impact, and workflow efficiency. Reports can be viewed at the organization level or filtered by individual account, making it easy to track performance across multiple locations or clients.
How do I get started?
Contact our team to schedule a demo and assessment. We'll evaluate your current workflows, recommend which agents will deliver the most value, and create an implementation plan tailored to your organization's needs and timeline.