Problem Statement

Duplicate-claim denials (OA-18) are high-volume, but they aren't uniform: some are true duplicates that should be written off, while others are false positives where the second claim is legitimately distinct (a different date of service, a repeat procedure missing a modifier, or a separate provider) and should be appealed. Resolving them means triaging each denial to tell the true duplicates from the recoverable ones, then carrying out the right follow-up for each, which is exactly the mixed, judgment-driven work that doesn't fit a single scripted path. Done manually at volume, it's a steady drain on follow-up staff, and misjudged denials either write off recoverable revenue or waste effort appealing genuine duplicates.

Automation Solution

This agent ingests duplicate-claim denials (OA-18), triages each to determine whether it's a true duplicate or a recoverable claim, and manages the appropriate follow-up activities through to resolution.