Finds the reason the claim will be denied, before you submit it
Most claim denials are administrative, not clinical: a code the note does not support, a missing modifier, an authorisation nobody obtained, a place-of-service mismatch. Each one is rework, and rework at volume is the largest avoidable cost in a billing operation.
This agent checks a coded claim before it goes out. It compares each code against what the documentation actually records, checks the claim against the payer rules in your knowledge base, and reports what would cause a denial — with the rule and the part of the note that does or does not support it.
It does not assign codes, does not diagnose, and does not assess whether treatment was appropriate. Those are a clinician's and a certified coder's work. It reads what was written and what the payer requires, and reports where they do not meet. Everything it produces goes to a person to act on.
Caught before submission, when fixing costs minutes instead of weeks.
Coders see only claims with a flagged reason, each already evidenced.
Every flag traces to a rule and a line of the note.
Whether the note actually records what the code claims, quoting the part that does or does not.
Read from your knowledge base, so it is that payer's policy rather than a generic ruleset.
Missing modifiers, authorisations, place-of-service mismatches, and required attachments.
A code the note contradicts and a code the note is silent on are different problems with different fixes.
It reports; a certified coder decides. Coding is a credentialed act and stays one.
No diagnosis, no assessment of whether care was appropriate.
This agent runs server-side through the PROMIVO runtime. Each run is logged step by step and every tool call is permission-checked before it executes.
Demo dataIllustrative sample output, abridged.
{
"codes": [],
"payer": "Regional Health",
"documentation": "…",
"claimReference": "CLM-9931"
}{
"escalate": false,
"findings": [
{
"code": "99214",
"rule": "Level 4 established patient visits require documented medical decision-making of moderate complexity, or total time.",
"issue": "not-documented",
"sourceDocument": "Regional Health Provider Manual 2026 — section 7.4",
"denialLikelihood": "likely",
"documentationSupport": "The note records a brief follow-up with no examination findings and no time recorded. Nothing in it addresses the level billed."
}
],
"disclaimer": "A documentation and payer-rule check. Not coding advice, not a clinical opinion, and not a finding that this claim is correct or payable. A certified coder must review.",
"payerRulesFound": true,
"observationsForCoder": [
"The documentation as written appears to describe a lower level of service. This is an observation, not a code assignment."
]
}No integrations required.
Check the batch before it goes to the payer.
Find the pattern behind a run of denials.
Show clinicians which notes routinely fail to support coding.
$399/month
Billed monthly through your PROMIVO subscription. Cancel at any time.
Runs consume your plan allowance for agent executions and tokens. See plan limits.
No. Coding is a credentialed act with legal weight. It checks codes already assigned against documentation and payer rules, and reports discrepancies for a coder to resolve.
No. It never diagnoses, never assesses whether care was appropriate, and never comments on a clinician's decisions. It reads what was documented and what the payer requires.
Supply de-identified records wherever possible; the audit works from documentation and codes, not from identity. Your own handling of protected health information remains your responsibility, and this agent does not transmit records anywhere.
It checks documentation support only and says the payer check could not be performed. It will not substitute a generic ruleset for the payer's own.
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