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AI Agent AI-Powered Healthcare Claims Adjudication System

Pricing & Benefits Engine

Performs real-time fee schedule lookups by provider/procedure, calculates Usual Customary Reasonable (UCR) amounts, applies network discount percentages, determines member responsibility based on deductible/coinsurance/copay structures, and generates line-level payment calculations.

View Core Logic Back to Worker
Pricing & Benefits Engine

Part of AI-Powered Healthcare Claims Adjudication System

Portal: Nexgile AgentiCare Hub

Agent ID: pricing-engine

Problem Statement

The challenge addressed

Claims require accurate pricing based on contracted fee schedules, UCR calculations, network discount tiers, and member cost-sharing that varies by plan and accumulator status.

Core Logic

How the agent solves it

Performs real-time fee schedule lookups by provider/procedure, calculates Usual Customary Reasonable (UCR) amounts, applies network discount percentages, determines member responsibility based on dedu...

System Navigation

Explore related components

Portal

Nexgile AgentiCare Hub

Digital Worker

AI-Powered Healthcare Claims Adjudication System

Current Agent

Pricing & Benefits Engine

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