Payer Policy Search Agent
Answers staff questions about what an insurer covers, quoting the current policy.
The challenge
Finding the right answer means reading through large volumes of documents. It takes skilled people hours and is easy to get wrong under time pressure.
How it works
- 1A question or a document arrives.
- 2The agent searches your data, limited to what the person is allowed to see.
- 3It writes up what it found, with a link to the source for every point.
- 4It checks each point against its source and removes anything it cannot support.
- 5Your expert reviews the result and makes the final call.
Your people stay in control
Every point links to its source so your expert can check it. The expert, not the agent, makes the final call.
Systems we work with in Healthcare
- Electronic health records via FHIR and HL7
- Practice management and scheduling
- Payer portals and clearing houses
- Contact-centre telephony
- Imaging and lab systems
How we measure success
- Time saved per question
- How often the sources are right, checked against your experts
- How much your experts change the result
Kind of work
Research and review. The agent reads large volumes of documents and answers questions, showing the source for every point.
More in Healthcare
Clinical Intake & Triage AgentAnswers patients at any hour, asks about their symptoms, judges how urgent the case is and directs them to the right care.Prior Authorisation AgentPrepares and submits requests for insurer approval of treatment, then follows them up, so staff handle only the exceptions.Clinical Note-Taking AgentListens to the appointment, writes up the clinical notes and prepares the orders for the clinician to check and sign.Claim Denial Management AgentReads why an insurer refused a claim, writes the appeal with supporting evidence and resubmits it.
Want this working in your organisation?
We can show it working on real examples from your business before you commit to a full build.