Join Us at HLTH 2024! Find us at kiosk #3370-26 in the Club Startup pavilion at The Venetian Expo (Level 2).
Resolve Cases Faster, Fairer, and More Transparently
AI-powered Appeals & Grievances Agents streamline case intake, triage, and resolution, ensuring compliance and member trust.
What Are A&G AI Agents?
A&G AI Agents handle the intake, triage, clinical summarization, and decision support for appeals and grievances. They automate repetitive tasks while providing explainable recommendations for complex clinical and policy decisions.
Our Appeals & Grievances AI Agents
Intake Agent
Captures and structures case details with guided workflows from multiple channels including AI OCR.
Streamlines case capture and ensures accurate data structuring across all intake channels.
Clinical Evidence Agent
Summarizes clinical data for medical necessity review while keeping member data in focus.
Provides focused clinical summaries that prioritize member context for accurate reviews.
Recommendation Agent
Provides recommendations to staff on case determination based on clinical evidence analysis.
Supports staff decision-making with intelligent recommendations for consistent case outcomes.
3-Step Automation Process
Data Intake
Intelligent Processing
Output & Integration
Where Appeals & Grievances Agents Shine
Resolving Member and Provider Requests Efficiently
Appeals
Intake & Triage
Medical Necessity Review
Coverage Determinations
Clinical Evidence Summarization
Case Routing & Escalation
Ready to Accelerate Your Appeals & Grievances?
Streamline case intake, clinical review, and determinations with our A&G AI Agents.
Ready to Accelerate Your Appeals & Grievances?
Streamline case intake, clinical review, and determinations with our A&G AI Agents.
