Pre-Bill Edit Review Agent

Before claims go out, edits catch problems like bundled procedures, missing modifiers or diagnoses that do not support the procedure. Working them by hand is slow. When a claim hits an edit, this agent looks up the specific rule and reads the chart for that service. It works out whether a modifier is justified, the code should change or the diagnosis link should move, and drafts the fix with the reason. Modifiers need documentation of a separate service; it never adds one just to bypass an edit. Diagnosis links follow the documentation. If the chart supports no fix, the claim is held and routed to a coder or provider question. A coder approves every change. After the fix, it reruns the edit, and loops back if the claim still fails. Edge case: an unsupported claim is held rather than forced through.