Revenue Cycle · Medical Billing Automation

Your Own AI Agent
for Medical Billing

The average practice loses 15–20% of billed revenue to denied claims, missed follow-ups, and billing errors. Not because the staff isn't working — because the volume is unmanageable manually.

This agent handles your denial queue, eligibility checks, prior auth tracking, AR follow-up, and coding review — automatically, every day. Built on n8n. One-time build. You own it forever.

11.8%
Average initial claim
denial rate in 2024
$19.7B
Spent annually fighting
denied claims (AHA)
54%
Of denied claims are
ultimately overturned
$0
Monthly platform fee
once you own it
Josh Leavitt

"Every billing director I've talked to says the same thing — 'we know money is falling through the cracks, we just don't have the bandwidth to catch it.' Denied claims, aging AR, missed eligibility checks. It's not a people problem, it's a volume problem. This agent is the extra staff member who never misses a denial, never forgets a follow-up, and works through the queue while your team focuses on the exceptions that actually need a human."

Josh Leavitt
Founder & CEO, Omni Online Strategies
What It Handles

Five Revenue Cycle Jobs.
One Agent.

Claims Denial Management
Ingests denied claims, reads EOB reason codes (CO-4, CO-11, CO-97, PR-96), classifies appealability, generates appeal letters with the right clinical language, and routes for resubmission.
Highest ROI
Eligibility Verification
Batch-verifies the next 3 days of scheduled patients overnight. Flags insurance issues, confirms deductibles and copays, and delivers a clean morning report to your front desk.
Daily run
Prior Authorization Tracking
Monitors your scheduling system for auth-required CPT codes. Auto-submits requests, tracks approval status, and alerts when auth is expiring or missing before the appointment.
Prevent denials
AR Aging & Collections
Segments aging buckets (30/60/90/120+ days), auto-sends patient balance reminders, identifies actionable payer balances, and generates a weekly collections action list.
Recover revenue
CPT / ICD-10 Coding Review
Reads clinical notes and flags likely undercoding, ICD-10 specificity gaps, and CPT/diagnosis mismatches before claims go out. Catches the errors that cause downstream denials.
Before submission

Live Demo

Watch the Agent Work a Denial

omni · medical-billing-agent · denial-processor
READY
$ process_denial —
CLM-48821
· Aetna PPO
Agent Decision
See the Difference

What Your Team Gets Back

✗  Without the Agent
✓  With the Agent
Billing staff manually works the denial queue — reading EOBs, looking up reason codes, deciding whether to appeal. 2–3 hours a day per person.
Agent processes every denial the same day it arrives. Appealable claims get letters drafted and routed automatically. Staff reviews exceptions only.
Eligibility verified for some patients, not all. Front desk calls insurance or logs into payer portals manually before each appointment.
Every patient on the next 3 days' schedule verified overnight. Morning report flags issues before the patient walks in the door.
Prior auth required for certain CPT codes. Staff catches it — sometimes. Patients get to the appointment and the authorization isn't in place.
Agent monitors the schedule for auth-required codes. Request submitted automatically. Approval tracked. Expiry alert sent.
AR report reviewed monthly, if at all. Balances sit 90–180 days before anyone works them. Write-offs happen because chasing feels pointless.
Automated outreach starts at day 30. Payer balances flagged by bucket. Collections action list generated every Monday morning.
Coding reviewed by whoever has time. Undercoding goes unnoticed. Vague ICD-10 codes sail through internally and get denied by payers.
Every claim reviewed for specificity and CPT/ICD-10 match before submission. Flags caught internally, not after a denial.
54%
Of denied claims overturned on appeal — most never get worked
$450
Average value per medical necessity denial in 2025 — up 70% YoY
24/7
Agent monitors claims, AR, and eligibility continuously
Days
To deploy — not months. No EHR replacement required
The Process

How It Works, Start to Finish

Step 01
Scheduled Triggers Fire
n8n runs on configurable schedules — denial processing daily, eligibility verification each evening, AR aging weekly. New denials arriving via email or clearinghouse EDI trigger immediate processing without waiting for the next scheduled run.
n8nn8n Scheduler
SupabaseSupabase · Claims Queue
Step 02
Denial or Claim Data Ingested
Denied claims come in via clearinghouse ERA/835 files, payer portal export, or direct email from your billing team. The agent parses reason codes, claim amounts, service dates, CPT and ICD-10 codes, and payer response text automatically.
GmailGmail · Denial Inbox
SupabaseSupabase · Claims DB
SheetsSheets · Import
Step 03
AI Classifies and Scores
The AI reads the denial, cross-references the reason code, evaluates payer history for this CPT code, assesses documentation quality, and scores appealability 0–100. It identifies the specific fix — missing modifier, wrong diagnosis code, untimely filing, medical necessity — and routes accordingly. Not a rule engine. Actual reasoning.
OpenAIOpenAI
AnthropicAnthropic
GeminiGemini
Step 04
Appeal Letter Generated
For appealable denials, the agent generates a complete appeal letter — claim details, medical necessity language, regulatory citations, and supporting documentation checklist. Output matched to payer format where possible. Your biller reviews, clicks send. No drafting from scratch.
OpenAIOpenAI · Letter Generation
Google DriveGoogle Drive · Templates
Step 05
Everything Logged to Your Dashboard
Every denial, outcome, appeal status, and recovery amount written to Supabase and synced to your Google Sheets dashboard. Payer denial trends, reason code breakdown, appeal success rate by payer — all visible without logging into another platform.
SupabaseSupabase · Revenue Log
SheetsGoogle Sheets · Dashboard
Step 06
Smart Alerts Routed
High-value denials and time-sensitive appeals get immediate Slack alerts to your billing manager. Patient balance reminders sent automatically by email or SMS. Weekly AR digest lands Monday morning before anyone gets to their desk. Write-off risks escalated before it's too late to appeal.
SlackSlack · Billing Alerts
GmailGmail · Patient Outreach
TwilioTwilio · SMS
Pricing Reality

Own It. Don't Rent It.

Enterprise RCM Platform
Waystar / Availity / AKASA
$40K–$100K+
per year · enterprise contract
✗ 6–12 month implementation timelines
✗ EHR integration projects required
✗ Per-user seat fees add up fast
✗ Annual price increases locked in
✗ Built for health systems, not your practice
Custom AI Agent · Omni
Your Medical Billing Agent
One-time
build fee · low monthly API ops cost
✓ Deployed in days, no EHR replacement
✓ Configured for your specialty and payer mix
✓ You own the system — no vendor lock-in
✓ Scales with your volume, not your seat count
✓ AI that reads context, not just reason codes
Where We Get the Data

Works With Your Existing Systems

No rip-and-replace. The agent connects to what you already use — your clearinghouse, your EHR export, your payer portals — and layers intelligence on top.

Clearinghouse
ERA / 835 Files
Electronic remittance advice parsed directly — claim amounts, reason codes, payer responses, adjustment codes.
Payer APIs
Availity · Waystar
Real-time eligibility checks, claim status, and prior authorization submissions without manual portal logins.
EHR Export
Athena · Epic · Kareo · Tebra
Scheduled data exports or API integration with your existing EHR for scheduling, coding, and clinical note access.
CMS · NUCC
CPT / ICD-10 Codebooks
Current code sets for validation, specificity checking, and CPT-to-diagnosis pairing logic. Updated with each annual release.
Payer Policies
LCD / NCD Coverage Rules
Local and National Coverage Determinations checked before submission to flag medical necessity issues before payers see them.
Patient Comms
Email · SMS · Portal
Automated patient balance outreach, appointment reminders with insurance reminders, and prior auth status updates.
Tools Used

The Stack

n8nn8n
OpenAIOpenAI
AnthropicAnthropic
GeminiGemini
SupabaseSupabase
GmailGmail Google SheetsGoogle Sheets Google DriveGoogle Drive
SlackSlack
TwilioTwilio
AirtableAirtable
Let's Talk

Stop losing revenue
to the denial queue.

We'll build you an AI billing agent configured for your specialty, your payer mix, and your team's workflow. One-time build. You own it outright.

Book a Free Consultation  → View All Automations
No commitment required  ·  Typical deployment under 2 weeks

This page is a demonstration of automation capabilities only. All claim data, payer names, denial scenarios, dollar amounts, and outcomes shown are illustrative examples created to demonstrate how an AI billing agent can work. Any resemblance to real claims, patients, or payer decisions is coincidental. Actual deliverables, workflows, integrations, and results depend entirely on each client's specific systems, payer mix, EHR environment, and business requirements. Omni Online Strategies builds custom solutions — final scope is determined during a discovery process with each client.