Shift Agents · Denial Management
AI denial management that works every denied claim before the filing limit.
The Denial Management Agent finds denials, rejections and claims that were simply never paid, works out why, fixes the cause with the other agents, and resubmits before the filing limit. The fix is saved as a rule for that payer, so the same denial doesn’t come back.
Claim #88214
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Denial Management Agent
No payment 45 days after submission.
Checking status with the payer…
The payer has no record of the claim.
Found: rejected at the clearinghouse, never worked.
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Insurance Verification Agent
Rejection reason: member ID not found.
Re-verifying with the new ID…
Memory: This payer reissues member IDs every January.
Correct member ID on file. Coverage active.
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Denial Management Agent
Rebuilding with the new member ID…
Resubmitted.
Accepted by the payer, 11 days inside the limit.
What it does
What it works
Denials
Classified by reason, like CO-197 for a missing auth.
Rejections
Claims that never reached the payer at all.
Silent claims
No payment and no denial, found by checking status.
Secondary claims
Billed with the primary EOB attached.
Payer rules
Each fix saved, so the same denial doesn’t recur.
Where it works
Where it fits in the journey.
The line it won’t cross
It knows when a person must sign.
Routes resubmissions to a coder or clinician for payers whose contracts require sign-off, rather than assuming its own authority.
Everything else it can fix and resubmit itself is logged with the reason.
See every agent’s guardrails →How it connects
Works inside the systems you already run.
Your EHR / PM
Reads and writes in the systems your team already uses.
- athenahealth
- NextGen
- AdvancedMD
- eClinicalWorks
- Greenway
- ModMed
- SIS
Clearinghouse and payers
Claims, remittances and claim status.
- EDI 837
- EDI 835
Questions
Denial Management Agent, answered.
Does it only handle denials?
No. It also finds claims rejected at the clearinghouse and claims that were never paid or denied, which often go unnoticed the longest.
How does it stop the same denial recurring?
When it fixes a denial, it saves the fix as a rule for that payer, such as attaching the auth to every claim up front.
Does anyone review what it resubmits?
For payers whose contracts require a coder or clinician to sign off, it routes the resubmission to your team instead of sending it itself.
Does it work with our EHR?
It works with athenahealth, NextGen, AdvancedMD, eClinicalWorks, Greenway, ModMed and SIS, using APIs where they exist and Browser Agents where they don’t.
How is patient data protected?
Every customer gets a BAA, data is encrypted in transit and at rest, and each agent sees only what its task needs. Every action is logged with its reason.
Works alongside
Charge Capture Agent →
AI charge capture that bills what the note supports, and nothing more.
Insurance Verification Agent →
AI insurance verification that catches coverage problems before the visit.
Patient Balances Agent →
AI patient balance collection that checks the bill before it asks for payment.
See the Denial Management Agent work a week like yours.
20 minutes, with Lance Rodela, founder.