AI Agent Suite for revenue cycle management
One connected AI workforce for the work behind reimbursement
Rinova deploys specialized AI Agents across your existing revenue cycle. Each agent follows a defined workflow, shares status with the next step, and sends exceptions to your staff for review.
Seven agents across one connected process
Open any stage to see the input it reads, the action it takes, and the output it produces.
- Stage 1Eligibility VerificationConfirm coverage and benefits before the visit through payer APIs and portal workflows.
- Input
- Appointment schedule and patient insurance data
- Agent action
- Checks APIs and payer portals, collects benefits, and applies the organization's verification rules
- Output
- Verified details in the approved destination or an exception task
- Stage 2Prior AuthorizationGather requirements, prepare routine requests, submit through payer portals, and monitor status.View agent
- Stage 3Medical CodingRead documentation, apply organization-specific coding guidance, and route low-confidence cases for review.
- Input
- Clinical documentation and coding guidance
- Agent action
- Extracts relevant documentation, applies coding logic, scores confidence, and performs configured checks
- Output
- Review-ready codes or a flagged case
- Stage 4Claim SubmissionCheck required fields, submit clean claims, capture confirmations, and respond to front-end rejections.
- Input
- Coded encounter and claim data
- Agent action
- Validates required fields, submits the claim, and captures the response
- Output
- Submission confirmation or a corrected work item
- Stage 5Payment Posting and ReconciliationRead remittance data, post payments, compare expected and received amounts, and flag mismatches.
- Input
- ERA, EOB, payment data, and approved financial records
- Agent action
- Matches payments, posts line items, compares expected and received amounts, and identifies variance
- Output
- Reconciled payment or exception
- Stage 6Rejection and Denial ManagementIdentify root causes, prepare corrections or appeal work, and keep every next action visible.
- Input
- Rejection or denial response and claim history
- Agent action
- Categorizes the issue, assembles the next action, and executes approved corrections or prepares appeal work
- Output
- Resubmission, appeal task, or escalated case
- Stage 7Claim Status and Follow UpCheck payer and clearinghouse status, update work queues, and surface claims that need action.
- Input
- Open accounts receivable inventory
- Agent action
- Checks APIs and payer portals, updates status, and applies follow-up rules
- Output
- Updated work queue and next action
Specialized agents with shared context
Each AI Agent is responsible for a defined task, but the work does not occur in isolation. Status, confidence, exceptions, and completed actions can move with the claim so the next workflow begins with the information it needs.
Synthetic claim SIM-CLM-51002
Simulated workflowEvery configured check passes, so the claim moves through the suite and staff are not interrupted.
- Eligibility VerificationCoverage confirmed and written to the recordAgent completes
- Prior AuthorizationNot required for this simulated serviceNot applicable
- Medical CodingHigh-confidence codes linked to documentationAgent completes
- Claim SubmissionClean claim submitted and acknowledgedAgent completes
- Claim Status and Follow UpStatus checked on schedule until paymentAgent completes
- Payment Posting and ReconciliationRemittance posted and reconciledAgent completes
Your team sets the boundaries
Rinova is configured around customer-approved actions, confidence thresholds, and escalation rules. Routine work can continue automatically. Sensitive, unusual, or low-confidence cases enter a queue with the relevant context so staff can review and decide the next step.
Human review queue
Simulated workflow| Reason | Item | Status | Owner | Due date |
|---|---|---|---|---|
| Missing subscriber ID | SIM-APPT-0429 | Review required | Front desk | Due in 1 day |
| Clinical attachment required | SIM-ORDER-3318 | Review required | Clinical team | Due in 2 days |
| Low coding confidence | SIM-ENC-7751 | Review required | Coding | Due in 1 day |
| Payment mismatch | SIM-ERA-2209 | Review required | Accounts receivable | Due in 3 days |
Deploy in stages
Full-suite customers typically begin with two AI Agents during an approximately two-month onboarding and validation period. Once the first workflows are approved for live use, Rinova expands the suite one agent at a time. This staged approach gives the organization time to confirm results, refine exceptions, and prepare staff for each new workflow.
Map
We document the current workflow, systems, guidelines, handoffs, and exception rules across the revenue cycle.
Build
We configure customer-specific instructions and connect each agent to the approved parts of the workflow.
Validate
Your team reviews test cases, confirms outputs, and approves the first two agents for live work.
Expand
Once the first workflows are approved, Rinova adds the remaining agents one at a time.
What connected automation can improve
80 to 90%
Roughly 80 to 90 percent of routine revenue cycle work automated, depending on scope
98%+
More than 98 percent first-pass claim acceptance
<2%
Less than 2 percent Rinova-reported denial rate
Up to 5x
Up to 5 times faster reimbursements
At suitable volume, organizations running the full suite can reach revenue cycle management expenditure of approximately 0.7 to 1 percent of revenue.
Results vary by organization, specialty, payer mix, claim volume, system access, workflow scope, and starting performance.
Find the first two workflows to automate
We will review your revenue cycle, identify high-volume repeatable work, and show how the first agents would operate in your systems.