acufy-claims review console
AI-native multi-tenant healthcare claims adjudication. Each claim flows through a 7-agent mesh; verdicts that don't pass the auto-approval policy land in the pend queue for human review.
Agent chain
- 1.
intake_validatorStructural sanity check; resolves member + provider IDs. - 2.
eligibilityWas the member enrolled on the date of service? - 3.
auth_matchWas the required prior auth on file (when applicable)? - 4.
coding_editsNCCI/MUE/modifier rule reasoning. - 5.
medical_necessityCoverage policy criteria (LCD/NCD-style). - 6.
pricingAllowed/plan/member dollar amounts via fee schedules. - 7.
dispositionAggregates the six upstream verdicts into the final decision. - 8.
review_gateTenant policy decides: auto-commit or pend to human.