Custom, built in days
Claims agent for HL7 feeds
The claims agent for HL7 feeds fetches the invoice a claim is waiting on from HL7 feeds.
Coastline Medical SchemeClaims agentWhatsApp
- Customer: Why do I still owe R640 on this?
- Read statement dated 3 OctoberHL7 feeds
- 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 HL7 feeds
- Fetches the invoice a claim is waiting on from HL7 feeds
- Receive admission, discharge and result messages as they happen
- Start a follow-up call after a discharge message
- Turn a result message into a plain-language explainer for the person it belongs to
Questions
What does the claims agent do with HL7 feeds?
Fetches the invoice a claim is waiting on from HL7 feeds.
Is the HL7 feeds connector live?
Not yet as a ready-made connector.
Does the claims agent change claim outcomes?
No.
Does the agent write into HL7 feeds?
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.