Overview
At AGS Health, we’re transforming the role of automation in the revenue cycle with Agentic AI—a new class of intelligent digital agents designed to collaborate, adapt, and deliver real business outcomes. These AI agents go beyond simple task automation, bringing the power of decision-support and human-like reasoning to complex healthcare workflows.
Whether you need single-purpose digital agents or multi-agent systems, AGS Health can help you orchestrate your digital workforce and unlock the full potential of your revenue cycle.
Collaborative Team Empowerment
Our AI RCM agents work alongside your staff, understanding natural language, learning from instructions, and offering suggestions so your team can focus on strategic oversight and quality assurance.
Workforce Adaptability at Scale
AGS digital agents allow your RCM operations to scale without proportional headcount increases by adapting to evolving rules and workflows, reducing IT burdens, and enabling rapid onboarding of new facilities, specialties, and payer types.
Outcome-based Autonomous Decisions
Our agentic automation solutions focus on outcomes by dynamically analyzing context, providing data-driven recommendations, and prioritizing the next best actions based on your unique goals and strategies.
Agentic automation drives and manages a more efficient, well-coordinated workforce.
AI Agents
Autonomously handle complex tasks, reducing manual effort and accelerating outcomes.
AI Augmented RCM Professionals
Apply expertise and judgment to resolve exceptions and drive strategic improvements.
Process Automations
Streamline repetitive workflows for faster, error-free execution at scale.
Secure Governance
Ensure compliance, data integrity, and controlled access across all activities.
Seamless Synchronization
Keep systems, agents, and people aligned in real-time for smooth operations.
OUR PROCESS
Proven processes for rapid engineering and deployment
Our automation engineers collaborate closely with customers to gain a detailed understanding of their strategic goals and unique needs. They review and assess your revenue cycle processes, including data access and availability, documentation, staffing, current practices, and technologies, to identify the most impactful opportunities to enhance revenue cycle performance through AI agents and process automation.
AGS Health has developed and operates over 500 digital agents in various RCM applications. Our AI RCM agents can be deployed within weeks to meet your organization’s urgent scalability requirements.
Our automation engineers conduct research interviews with key stakeholders to understand current needs and challenges.
After the research is complete, our team performs a gap analysis and feasibility assessment for deploying digital agents, including documentation and integrations with key systems.
We then develop a proposal detailing development timelines, projected return on investment, and contractual agreements to proceed.
Upon contract completion, AGS Health’s engineers will rapidly develop and deploy digital agents.
AGS Health maintains the digital agents and provides updated data based on feedback and results.
APPLICATIONS
Meet some of our digital agents.
Authorization Agent
The Authorization Agent automates prior authorization by identifying payer-specific requirements, gathering supporting documentation, and submitting requests electronically or via payer portals. It tracks status updates, flags issues, and helps prevent delays and denials—improving turnaround time and workflow efficiency.
Benefits Delivered:
- 50% of production is performed by digital agents
- 90-95% accuracy in IV and authorization determination
Eligibility Agent
The Eligibility Agent verifies insurance coverage and benefits, including plan type, deductible, copay, coinsurance, and policy status, using electronic transactions, payer portals, or phone outreach. By flagging issues like inactive coverage or coordination of benefit (COB) conflicts before service or billing, it reduces eligibility-related denials and boosts clean claim rates.
Benefits Delivered:
- Reallocation of labor to complex tasks
- Reduced touches and faster processing of claims
- Annual savings ranging from $72K to $194K
Denials Agent
The Denials Agent automates denial intake, classification, and routing based on payer-specific rules and remittance data to determine the best resolution strategy for appeal, correction, resubmission, or write-off. It detects recurring denial trends, accelerates resolution, and helps improve recovery rates while reducing A/R days.
Benefits Delivered:
- 98.1% automated success rate
- 100% turnaround time (TAT) adherence
- Rapid reduction of backlogs
- Over $18M recovered annually
- More than 40% reduction in AHT
- 15% increase in productivity
Appeals Agent
The Appeals Agent automates appeal packet creation and submission by compiling denial details, explanation of benefits (EOB), supporting clinical documentation, and payer-specific templates. Using the appropriate appeal template based on the specific payer and denial code, it drafts customized appeal letters, submits them through the correct channel, tracks the status, and escalates cases lacking timely responses—boosting overturn rates and ensuring timely, consistent follow-up.
Benefits Delivered:
- Over 10K automated appeals prepared and submitted per month
- Replaced the need for over 50 full-time employees
- 98% accuracy in appeals submitted
Other common applications of digital agents include:
Patient Access Agents
- Pre-certification and adjudication
- Demographic and address validation
HIM and Clinical Agents
- Validation, classification, and indexing of faxed medical records
- Release of information
- Chart requests
- Mail processing
Patient Financial Service Agents
- Payment posting and reconciliation
- Claim status check/updates
- Remittance processing
- Transition to collect
UNPARALLELED EXPERIENCE
Custom-developed solutions without the hassle.
For most healthcare providers, in-house development and implementation of a digital workforce can be costly, requiring experienced developers and access to development tools with recurring licensing or subscription fees.
AGS Health’s AI agents are among the most competitive in the industry, delivering high-impact automation with a demonstrable return on investment at a fraction of the cost. Our certified team of engineers is complemented by best-in-class development tools, including but not limited to:
FLEXIBLE SUPPORT
Get the support you need. No more, no less.
Our flexible digital workforce management services support healthcare organizations with varying degrees of ongoing oversight and management.
Fully Managed Services
Our developers will build digital workers using our in-house technologies. Ongoing performance monitoring, analytics, and digital workforce upkeep services are made available as optional services.
Self-Managed Services
Organizations that have already invested in development tools but require additional support at an affordable cost can leverage our development resources on an ad-hoc basis while handling monitoring, analytics, and upkeep in-house.
ANALYTICS AND REPORTING
Supervise your digital workforce more efficiently than ever.
With AGS Health, managing a digital workforce has never been more efficient. Our intuitive and customizable dashboards make it easy to maintain, monitor, and report on the performance of your AGS-developed digital workforce. Whether automating data entry, data classification, data extraction, reporting, form completion, or other activities, our analytics dashboards make it easy to stay current on the status of your digital workflows and share progress with senior management.
Simple Cloud-Based Implementation
Fast, simple implementation that requires little to no IT support and can scale rapidly on demand.
Customizable Dashboards
Gain an at-a-glance view of status information for each of your digital agents.
Real-Time Reporting
Build executive reports and review the performance KPIs of your digital agents instantaneously.
Seamless Data Integration
Fluidly exchange data across your existing task and workflow management platforms, including EMR, ERP, and practice management systems.
Agent Maintenance and Support
Ensure successful long-term upkeep and optimization of digital agents with the support of our certified developers.
Address Exceptions and Anomalies
Easily identify and address potential exceptions and anomalies with alerts and automated workflow transfers across internal teams or AGS service representatives. *
* AGS outsourced services, including patient access, HIM and clinical, and patient financial services, are optional services not included in the AGS AI Platform.
FAQS
Frequently Asked Questions
What characteristics differentiate agentic automation from traditional robotic process automation?
Agentic automation is significantly more dynamic and intelligent than traditional robotic process automation (RPA) or scripted bots. Key differences include:
- Autonomy: Agents make decisions and act without requiring predefined rules or workflows.
- Contextual awareness: They understand the intent and context of tasks, allowing them to adapt in real time.
- Goal-oriented: Agents pursue specific business outcomes rather than following a linear script (e.g., closing a claim).
- Multi-step reasoning: They can plan, learn from feedback, and adjust actions mid-process.
- Inter-agent collaboration: Multiple agents can coordinate complex workflows together, much like human teams.
What benefits can I expect when implementing agentic automation in my revenue cycle?
Healthcare organizations can expect to see transformational value, such as:
- Faster reimbursement: Reducing the lag in claim processing and follow-up leads to quicker cash flow.
- Lower cost-to-collect: AI agents reduce the need for manual intervention across high-volume tasks.
- Increased staff efficiency: Human workers can focus on exceptions and higher-value work.
- Improved accuracy: Agents reduce errors in data entry, claim coding, and appeals.
- Scalability: Automation can flex with patient volume and payer complexity without adding headcount.
How long does it take to implement AI agents?
Implementation typically follows a phased approach, with:
- Minimum viable product use cases going live in 4–8 weeks
- Full deployment scaling in 3-6 months, depending on the complexity of the environment, use case selection, and system integrations.
Importantly, agentic systems require less rigid configuration than traditional RPA, so deployment cycles are often faster and more adaptable.
How should I plan and prepare for the implementation of AI agents?
Success depends on planning across people, processes, and platforms. Key steps include:
- Identify high-friction workflows: Look for repetitive, rules-based tasks with high volume and low complexity.
- Engage stakeholders early: Involve operations, IT, compliance, and revenue integrity teams from the start.
- Define clear goals: Whether it’s faster denial resolution or improved days sales outstanding (DSO), all key performance indicators (KPIs) should be measurable.
- Start small and scale: Begin with a pilot (e.g., claim status follow-up) and expand to more complex workflows.
How do AI agents handle exceptions or denials that require nuanced human reasoning?
AGS Health employs a hybrid human-in-the-loop model. Our Agentic AI handles the bulk of the work. When a denial requires clinical judgment, policy escalation, or documentation not available in the system, the agent:
- Flags the task for human review.
- Routes it to the appropriate AGS team or the client’s internal staff, depending on the delivery model.
- Learns from human input over time to reduce future escalation needs.
This combination ensures both efficiency and high-quality resolution.
Is agentic automation HIPAA-compliant?
AGS Health’s agentic AI is HIPAA-compliant and aligned with all major U.S. healthcare privacy regulations.
- We host our solutions in secure, HITRUST-certified environments.
- We encrypt data at rest and in transit.
- We ensure all agents operate within strict access controls and audit trails.
AGS Health has passed security reviews from some of the country’s largest health systems and payers.
What training or support is needed for our staff to work with AI agents?
Training and support are minimal, as AGS handles working with the agents and provides reporting to understand the results. We work with client teams to adapt where needed.
What internal resources are required for successful deployment of AI agents?
Successful implementation requires collaboration across departments, but AGS minimizes the lift by managing most of the configuration and execution. You’ll typically need:
- IT for access provisioning and data mapping
- Operations to define current workflows and validate use cases
- Compliance/security to review our controls and data protection approach
We provide a dedicated implementation team to lead coordination and keep internal impact low.
connect with us
Build the digital agents that are right for your revenue cycle.
Contact our team today to discuss how AGS Health can help your organization streamline workflows, reduce costs, and drive revenue growth with a digital RCM workforce.
