Documentation

Getting Started

Welcome to the RCM Agent Architecture documentation. This guide will help you understand and implement our AI-powered revenue cycle management system.

Prerequisites

  • Basic understanding of revenue cycle management
  • API access credentials
  • Compatible EHR/Practice Management System

Quick Start

# Install RCM Agent SDK
npm install @rcm-agent/sdk

# Initialize the client
import { RCMClient } from '@rcm-agent/sdk';

const client = new RCMClient({
  apiKey: 'your-api-key',
  environment: 'production'
});

// Start processing claims
const result = await client.processClaim(claimData);

System Architecture

The RCM Agent Architecture is built on a microservices-based design with multiple specialized AI agents working in concert.

Core Components

Component Purpose Technology
Agent Orchestrator Manages agent lifecycle and coordination Node.js, Kubernetes
ML Pipeline Processes and analyzes claim data Python, TensorFlow
Message Queue Handles async communication RabbitMQ
Data Store Persistent storage for claims and analytics PostgreSQL, Redis

Agent System

Our multi-agent system consists of specialized agents, each responsible for specific aspects of the revenue cycle.

Agent Types

Note: Agents operate autonomously but can collaborate when complex scenarios require multiple expertise areas.

Eligibility Verification Agent

Automatically verifies patient insurance eligibility in real-time.

  • Connects to 5000+ payer systems
  • Real-time eligibility checks
  • Benefit details extraction

Claims Processing Agent

Handles claim creation, validation, and submission.

  • Automatic code validation
  • Modifier optimization
  • Scrubbing and error detection

Denial Management Agent

Monitors and manages claim denials with automated appeals.

  • Denial pattern recognition
  • Automated appeal generation
  • Success rate optimization

Workflow Configuration

Customize workflows to match your organization's specific requirements.

// Example workflow configuration
{
  "workflow": "claims-processing",
  "steps": [
    {
      "id": "eligibility-check",
      "agent": "eligibility-verification",
      "timeout": 30000
    },
    {
      "id": "claim-validation",
      "agent": "claims-processing",
      "rules": ["medicare-compliance", "modifier-check"]
    },
    {
      "id": "submission",
      "agent": "claims-submission",
      "retry": 3
    }
  ]
}

Integration Guide

Integrate RCM Agent Architecture with your existing systems.

Supported Integrations

  • Epic
  • Cerner
  • Athenahealth
  • NextGen
  • Custom EHR systems via API
Important: Ensure your integration complies with HIPAA requirements and follows our security guidelines.

Security & Compliance

RCM Agent Architecture is built with security and compliance at its core.

Security Features

  • End-to-end encryption for all data transmissions
  • HIPAA-compliant infrastructure
  • Role-based access control (RBAC)
  • Audit logging for all operations
  • Regular security assessments

Deployment Options

Choose the deployment option that best fits your organization's needs.

Cloud Deployment

Fully managed SaaS solution with automatic updates and scaling.

On-Premise

Deploy within your own infrastructure for complete control.

Hybrid

Combine cloud and on-premise components for optimal flexibility.