Case Study
Autonomous Claims Processing
How a Fortune 500 Healthcare Provider recovered $12M in lost revenue using Agentic AI.
The Problem
The client was facing a 15% denial rate on insurance claims due to manual coding errors and changing payer rules. This resulted in $50M+ annual revenue leakage and a backlog of 20,000+ claims requiring manual review.
The Agentic Solution
We deployed a swarm of autonomous agents integrated directly into their EHR. Agent A monitors doctor notes for ICD-10 specificity. Agent B cross-references payer policies in real-time. Agent C submits the claim and handles initial denials. The system learns from every adjudication.
The Hard ROI
$12M
Revenue Recovered (Year 1)
99.2%
First-Pass Acceptance Rate
40k
Man-Hours Saved