AgentHack submission type
Enterprise Agents
Name
Kalyan S
Team name
Neura Nova
Team members
@Annamalai, @Indhumathi, @Haripriya
How many agents do you use
One agent
Industry category in which use case would best fit in (Select up to 2 industries)
Healthcare Pharma
Complexity level
Advanced
Summary (abstract)
The current Denial Management process in RCM is heavily manual, involving agents reviewing EOBs, identifying denial codes, categorizing reasons, and initiating appeals or corrections. Basic automations like work queue routing and status tracking exist, but most critical thinking, data interpretation, and follow-ups remain human-dependent.
Detailed problem statement
The current Denial Management process in RCM is heavily manual, involving agents reviewing EOBs, identifying denial codes, categorizing reasons, and initiating appeals or corrections. Basic automations like work queue routing and status tracking exist, but most critical thinking, data interpretation, and follow-ups remain human-dependent.
Challenges in Current System (for Agentic Automation):
• Unstructured Data Handling: Denial data from EOBs, payer portals, and historical notes is often in free-text or scanned format, difficult for automation to interpret.
• Contextual Decision-Making: Manual agents rely on nuanced judgment to decide next steps, which basic bots can’t replicate.
• Lack of Real-time Insights: Limited analytics and trend prediction hinder proactive denial prevention.
• Process Fragmentation: Disconnected systems and data silos reduce automation efficiency.
• No Feedback Loop: Manual systems lack a learning mechanism to improve over time.
Detailed solution
Implement Agentic AI using UiPath to automate the end-to-end Denial Management process with intelligent, goal-driven agents.
Key Components:
• AI Extraction Agent: Uses UiPath Document Understanding to extract denial data from EOBs and portals.
• Denial Classification Agent: Identifies denial types and recommends resolution paths using AI models.
• Appeal & Follow-up Agent: Auto-generates appeal letters, submits follow-ups, and tracks responses.
• Root Cause Agent: Analyzes denial trends and flags systemic issues for correction.
• Learning Loop: Agents learn from outcomes and improve over time using UiPath AI Center.
• Orchestration: UiPath Orchestrator manages agent collaboration, with human validation via Action Center when needed.
Benefits:
• Reduces manual effort by 70–90%
• Speeds up resolution with intelligent decisions
• Improves accuracy and denial prevention
• Enables scalable, 24/7 operations
Demo Video
Expected impact of this automation
The Agentic AI-powered solution will transform Denial Management by shifting from reactive, manual handling to a proactive, intelligent, and scalable process.
Key Impacts:
• Up to 90% reduction in manual effort for denial identification, classification, and resolution
• Faster turnaround time for appeals and corrections, reducing A/R days
• Higher accuracy and consistency in denial categorization and action
• Significant reduction in recurring denials through root cause identification
• Improved recovery rate with timely and AI-driven appeal submissions
• Real-time insights and reporting to support denial trend analysis and strategic decisions
• Scalable operations with 24/7 agent execution and minimal human intervention
UiPath products used (select up to 4 items)
UiPath Integration Service
UiPath Orchestrator
UiPath Robots
UiPath Studio
Automation Applications
PMS, Payer Portal, Encoder Pro
Integration with external technologies
AWS, S3
Agentic solution architecture (file size up to 4 MB)
Sample inputs and outputs for solution execution
SERIES SCENARIO Invoice Number Patient First Name Patient Last Name Date of Birth Payor Member Ins ID Service Date - FROM Service Date - TO Billed Amount Outstanding Amount Billing Provider Billing Prov NPI Billing Provider Tax ID Organization Name
1 Complex P1368791280 ARIA BRIENNA PAGE HUGHES 04/29/2019 BLUE CROSS BLUE SHIELD BWQ937017548 2/1/2025 2/10/2025 $3,750.00 $3,475.00 FAHNESTOCK, ABBY 1336619238 352528741 Pediatrics
2 Simple P1375977611 JAXXSON BEITLER 01/02/2018 AETNA W833901728 4/1/2025 4/1/2025 $450.00 $450.00 DRESSLER, PAUL BERNARD 1730405523 352528741 Developmental and Behavioral Pediatrics
3 Simple with CALL P1376803180 ZAYDEN GILMORE 09/02/2020 HUMANA H467920228 3/9/2025 3/9/2025 $100.00 $100.00 GOODE, RACHEL HUFFINES 1992021364 352528741 Developmental and Behavioral Pediatrics
4 Medium P1376220801 KINSLEY DEAN 11/27/2014 CIGNA U129974679 5/12/2025 5/13/2025 $1,250.00 $1,250.00 TAYLOR, JOHN 1623455523 352528741 Developmental and Behavioral Pediatrics