Agent 03 — Autonomous RCM
Autonomous Revenue Cycle Management

Full-CycleRevenue, ZeroLeakage.

From patient appointment to final payment — 14 autonomous steps covering eligibility, coding, claim generation, scrubbing, submission, denial management, and revenue analytics.

Manual RCM Today

3–5days per claim

With Autonomous RCM Agent

<24h

Steps Automated

14

Clean Claim Rate

95%+

14

Workflow Steps

Patient to payment

100%

Claim Automation

Build, scrub & submit

<24h

Claim Submission

vs. 3–5 days manual

95%+

Clean Claim Rate

AI scrubbing & validation

14-Step Autonomous RCM Workflow

Every Dollar. Every Step.

From the first patient appointment to final revenue analytics — a complete autonomous RCM pipeline that eliminates revenue leakage at every stage.

01Intake

Appointment Scheduling

Patient / Scheduler

Patient appointment is scheduled with insurance captured, demographics collected, and reason for visit documented. This initiates the full revenue cycle pipeline.

Insurance capturedPatient demographicsReason for visit
02Intake

Pre-Visit Financial Clearance

Insurance Service

Eligibility is verified, benefits are checked, prior authorization is obtained, medical necessity is confirmed, cost estimate is generated, and patient responsibility is calculated.

Eligibility VerificationBenefits CheckPrior AuthorizationMedical NecessityCost EstimatePatient Responsibility
03Intake

Patient Registration

Front Desk / Patient

Digital intake forms are completed, insurance card is scanned via OCR, identity is verified, consent forms are signed electronically, and copay is collected.

Digital FormsInsurance Card OCRID VerificationConsent FormsCopay Collection
04Clinical

Clinical Encounter

Doctor / AI Scribe

Doctor conducts the visit while an AI medical scribe captures documentation in real time. Orders, labs, and clinical notes are generated and stored in the EHR.

Doctor VisitAI Medical ScribeDocumentationOrders/Labs
05Coding

Medical Coding

AI Coding Engine

Clinical documentation is automatically coded with ICD-10 diagnosis codes, CPT procedure codes, and HCPCS supply codes. Modifiers are detected and coding is validated.

ICD-10CPTHCPCSModifier DetectionCoding Validation
06Coding

Charge Capture

Billing System

Missing charges are detected and flagged. Duplicate charges are identified and removed. All services are mapped to the fee schedule for accurate billing.

Missing Charges DetectionDuplicate DetectionFee Schedule Mapping
07Claims

Claim Generation

Claims Engine

An 837 electronic claim is built from the encounter data. Required fields are validated, supporting documentation is attached, and a claim quality check is performed.

Build 837 ClaimValidate Required FieldsAttach DocumentationClaim Quality Check
08Claims

Claim Scrubbing

AI Scrubbing Engine

Claims are scrubbed for coding errors, eligibility issues, NCCI edits, LCD/NCD rule violations, and missing modifiers. AI predicts likely denials before submission.

Coding ErrorsEligibility ErrorsNCCI EditsLCD/NCD RulesMissing ModifiersPredict Denials
09Claims

Claim Submission

Clearinghouse / Payers

Clean claims are submitted electronically through the clearinghouse to Medicare, Medicaid, and commercial insurance payers with full audit trail.

ClearinghouseMedicareMedicaidCommercial Insurance
10Monitoring

Claim Status Monitoring

Monitoring Agent

Submitted claims are tracked in real time. Status is monitored for accepted, pending, rejected, and additional information requests from payers.

AcceptedPendingRejectedAdditional Information Requests
11Monitoring

Denial Management

Denial AI Agent

Root cause of denials is identified automatically. Missing records are collected, appeals are generated and submitted, and resolution is tracked to completion.

Identify Root CauseCollect Missing RecordsGenerate AppealSubmit AppealTrack Resolution
12Payment

Payment Posting

Payment Engine

Electronic Remittance Advice (ERA) is processed, EOBs are matched to claims, partial payments are reconciled, adjustments are applied, and write-offs are recorded.

ERA ProcessingEOB MatchingPartial PaymentsAdjustmentsWrite-offs
13Payment

Patient Billing

Patient Billing Agent

Remaining patient balance is calculated, a digital invoice is sent, payment plans are offered, an AI billing assistant handles inquiries, and collections are managed.

Remaining BalanceDigital InvoicePayment PlansAI Billing AssistantCollections
14Analytics

Revenue Analytics

Analytics Dashboard

Denial rate, days in A/R, net collection rate, cash forecast, and operational dashboards provide real-time visibility into the full revenue cycle performance.

Denial RateDays in A/RNet Collection RateCash ForecastOperational Dashboards
Agent 03 — Autonomous RCM

Stop Losing Revenue. Start Automating.

The Autonomous RCM Agent handles all 14 steps — from eligibility to analytics — so your team focuses on patients, not paperwork. Join the waitlist to get early access.