Claims Adjudication Support
Read claims and supporting documents, check them against policy, and prepare a decision for review.
- ISO 27001 certified
- SOC 2 Type II certified
- Zero data retention
- Full audit trail
The manual pain
Manual adjudication is slow and inconsistent, and errors drive appeals and rework.
What the agent does
The agent reads the claim and records, checks them against policy, and prepares a recommended decision with reasons for a reviewer to confirm.
What You Get
Concrete outputs, each one cited, logged, and reviewed by a person before it is relied on.
Runs on the Unified AI Execution Layer
This agent runs through the same governed path as every CreateOS workflow: routed to the right model, policy-checked before it acts, validated before it answers, and logged for audit.
More Healthcare Agents
Prior-authorization drafting
Assemble prior-authorization requests against payer rules, ready for a clinician to review and submit.
Clinical-note summarization
Draft encounter summaries from the record, cited and masked, for a clinician to confirm.
Patient intake and triage
Structure intake and route cases by urgency, with governed responses and a person in the loop.
Medical-records abstraction
Pull the specific data points you need from long records, cited and masked for review.
Coding and billing QA
Check codes against documentation and flag mismatches before claims go out.
Referral routing
Read referrals, check completeness, and route them to the right service without manual sorting.
