AGENT 12 / 11 · RETAIL & E-COMMERCE · REVENUE CYCLE MANAGEMENT (RCM)

Medical Coding Compliance Agent

Audits EHR clinical notes against ICD-11 and CPT codes before a claim is submitted — catching the mismatches that would otherwise surface weeks later as a denial.

READS FROMEHR clinical notes, CPT/ICD-11 code sets

MCP SERVERHealthcare Data Server

MODELRouted to reasoning-tier open model

HANDS OFF TOClaims Denial Triage Agent

RUN THE AGENT

Set your claim volume, model the audit impact

Adjust claim volume, error rate and the agent's catch rate and it recalculates flagged errors and monthly savings instantly.

ASSUMPTIONS

Monthly claims volume 15000

Baseline coding error rate 9%

Average claim value (£) 650

Agent catch rate, pre-submission 85%

Rework cost per caught error (£) 45

Cost per uncaught error reaching payer (£) 220

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Errors flagged pre-submission

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Errors still at risk

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Estimated monthly savings

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Clean-claim rate

Metric	Value

HOW IT WORKS

What the agent actually does

1. Pull the note and claim	Reads the EHR clinical note alongside the CPT/ICD-11 codes selected for the claim via the Healthcare Data MCP server.
2. Cross-check coding	Compares documented diagnoses and procedures against the code sets to flag mismatches before submission.
3. Score the risk	Estimates rework cost for flagged claims against denial cost for anything that would slip through unflagged.
4. Hand off	Routes flagged claims to coders for correction and clean claims onward, and feeds denial-reason patterns to the Claims Denial Triage Agent.