AutoGo Adjudicate
Claim Denial Classifier
Reads denied claims, classifies denial reasons against a taxonomy, cross-references clinical documentation, and proposes appeals for a claims officer to sign off.
At a Glance
What it does
AutoGo Adjudicate reads each denied claim, classifies the payer reason code against the taxonomy your billing team already uses, pulls the underlying clinical documentation from the hospital information system, and either proposes a resubmission with the missing document attached or escalates to a claims officer for judgement. The agent never submits or appeals on its own. Every proposed action carries its reasoning, and the officer signs off before anything is sent to the payer.
Key benefits
- Denial queue clears faster without abandoning the audit trail
- Consistent classification across payer, TPA, and corporate insurance denials
- Claims officer reviews reasoning, not raw denial rejections
- Proposed appeals grounded in the underlying clinical documentation
What sits inside this agent
Other agents on Healthcare EHR / Payer portals
Deployed alongside AutoGo Adjudicate for the same class of enterprise finance workflows.
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Prior Authorisation Preparation
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ViewWant AutoGo Adjudicate in your healthcare operation?
Tell us your systems and the workflow. We will scope AutoGo Adjudicate for your operation in a six to eight week pilot, reviewer-in-the-loop from day one.