Medical Coding and Claim Scrubber Agent

Problem

A denied claim costs around $25 to rework and is often written off instead. Most denials are not clinical disagreements - they are missing modifiers, mismatched diagnosis pointers, and payer rules nobody could memorise across the forty plans a practice touches.

Solution

An agent that proposes codes alongside the note text supporting each one, then scrubs the assembled claim against that payer's rules and shows what would be denied and why, before submission.

Tech stack

Required integrations

• EHR clinical notes
• Practice management or billing system
• Clearinghouse
• Payer policy sources

Key features

• Code suggestions with the supporting note excerpt attached
• Payer-specific scrub that cites the rule it applied
• Denial-reason prediction before submission
• Coder review queue that tracks accepts and overrides
• Audit trail of who accepted what and when