AI agents for medical billing & rcm
AI agents alongside AdvancedMD and Waystar. Denial triage, clean-claim prep, and patient collections run so billers work the exceptions, not the queue.
Systems of record this works alongside
Starter workflows
Denial triage and appeal prep
Read each denial, classify the cause, pull the supporting documentation, and draft the corrected claim or the appeal for the biller to submit. The queue gets worked by reason code instead of one denial at a time.
Claim scrubbing
Check claims against payer rules before submission, flag the ones likely to deny for coding, eligibility, or documentation gaps, and draft the fix, so the first-pass acceptance rate climbs.
Patient-balance follow-up
Run the patient-responsibility follow-up in a clear, respectful voice, offer the plan options the practice allows, and route disputes to a human. Collections improve without a call center feel.
Payer-portal reconciliation
Mirror remittance and claim-status data from the payer portals back into the billing system, so the biller has one place to look instead of logging into a dozen payer sites.
Revenue cycle is a queue that never empties
A medical billing operation lives in a set of work queues, denials, rejections, aging claims, patient balances, that fill faster than a team can clear them, and the aging that results is money the practice earned and did not collect. Ceven works those queues against AdvancedMD, Waystar, or Availity, triaging by cause and drafting the correction, so billers spend their time on the appeals that need judgment. The billing system stays the record; Ceven does the assembly and the follow-up around it, all logged.
Denials worked by pattern, not one at a time
Denials arrive in patterns, a payer rule change, a coding gap, an eligibility mismatch, but they get worked one claim at a time, which is why the denial queue never shrinks. Ceven reads the denials, groups them by cause, pulls the supporting documentation, and drafts the corrected claim or appeal, so the biller submits a batch of fixes instead of researching each one. The coding and clinical judgment stay with the certified staff; Ceven does the retrieval and the drafting.
Patient collections that keep the relationship intact
Patient responsibility is a growing share of revenue and the hardest to collect without souring the patient relationship, which is why so much of it ages out. Ceven runs the patient follow-up in a respectful, clear voice, offers the payment options the practice allows, and routes any dispute to a person, so collections improve without a heavy-handed feel. Patient data stays inside the billing company's tenant with a HIPAA-aligned posture, and every action is logged for the practice.
Frequently asked
Does the agent assign medical codes?
No. Medical coding stays with certified coders. Ceven scrubs claims against payer rules, triages denials, drafts appeals, and follows up on balances, all for a human to review and submit.
Does this work with Waystar and Availity?
Yes, both on the standard adapter, along with AdvancedMD and Tebra. Ceven reads claim and remittance data and drafts corrections on the billing company's authorization.
How is protected health information handled?
PHI stays inside the tenant with encryption at rest and row-level security, every access is logged, and Ceven maintains a HIPAA-aligned posture around the billing system.
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