Custom, built in days
Claims agent for FHIR API
The claims agent for FHIR API fetches the invoice a claim is waiting on from FHIR API.
Coastline Medical SchemeClaims agentWhatsApp
- Customer: Why do I still owe R640 on this?
- Read statement dated 3 OctoberFHIR API
- Claims agent: Your scheme paid R1,560 of the R2,200 specialist bill, at the scheme’s rate. The R640 left is the specialist charging above that rate. You could ask the rooms if they’ll accept the scheme rate.
- Customer: Can you ask them?
- Claims agent: I can draft the message for you to send, with the claim details. Want it?
What it can do with FHIR API
- Fetches the invoice a claim is waiting on from FHIR API
- Read people, appointments and observations from any system with a FHIR API
- Write a questionnaire response or a document back to the record
- Start an agent when a new appointment or result appears
Questions
What does the claims agent do with FHIR API?
Fetches the invoice a claim is waiting on from FHIR API.
Is the FHIR API connector live?
Not yet as a ready-made connector.
Does the claims agent change claim outcomes?
No.
Does the agent write into FHIR API?
Only what you allow: usually intake answers, call summaries and documents, for your clinicians to review.
Where do the agent’s answers about benefits come from?
From the scheme’s own published plan guide for the member’s option, and from statements the member sends.
Ollie’s agents give wellness guidance. They don’t diagnose or prescribe, and hand off to a human expert when needed.