Check and submit insurance claims

The scenario runs each claim through code, risk and denial checks, submits it, and escalates doubtful ones to a specialist.

  • Code and compliance checks on every claim
  • Denial risk assessed up front
  • Doubtful claims escalated to a specialist
  • A final report with metrics
Set it up for yourselfScriptera

How it works

To connect calltouch and Mautic, you don't need a developer: a ready-made scenario links them in minutes.

  1. Starts when: Schedule Trigger - Process Claims
  2. Then: Workflow Configuration
  3. Then: Simulate EHR/Billing Data
  4. Then: Orchestrator Agent
  5. Check: Route by Risk Level
  6. If yes: Check Compliance Flags
  7. If yes: Escalate to Revenue Specialist
  8. Check: Merge Results
  9. Then: Calculate Metrics
  10. Then: Format Final Report
  11. If no: Store Audit Trail
  12. If no: Store Claims Records
  13. If no: Store Denial Records
  14. Then: Coding Validation Agent Tool
  15. Then: Claims Submission Agent Tool
  16. Then: Denial Detection Agent Tool
  17. Then: Payer Follow-up Agent Tool
  18. Then: Orchestrator Output Parser
  19. Then: Coding Validation Output Parser
  20. Then: Claims Submission Output Parser
  21. Then: Denial Detection Output Parser
  22. Then: Payer Follow-up Output Parser
  23. Then: OpenAI Model - Orchestrator
  24. Then: OpenAI Model - Coding Validation
  25. Then: OpenAI Model - Claims Submission
  26. Then: OpenAI Model - Denial Detection
  27. Then: OpenAI Model - Payer Follow-up

You can launch this calltouch + Mautic integration in Scriptera: describe the task in plain words — the scenario is built, launched and monitored for you.

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