Denial received from the clearinghouse
Every claim, orchestrated.
We set it up and go live.
Tago Health’s orchestrator hands each claim to the right agent and brings your team in for the judgment calls. The agents work as teammates to your billers. We set it up with your rules, your guardrails and your knowledge, then go live.
The agents
Agents that work
Agents that work
beside your team.
The orchestrator decides what each claim needs next. Each agent does its part and hands the claim on, and your team approves the judgment calls. The agents are teammates and co-pilots for your billers, never a replacement for them.
Understand
Reads the denial reason and the payer rules, then picks the next step.
- Knowledge
- Payer rules and denial codes
- Guardrail
- Stops if the reason is unclear
Appeal
Drafts the appeal with the right records and submits it to the payer.
- Knowledge
- Your appeal playbooks
- Guardrail
- Approval above a threshold you set
Voice
Calls the payer and keeps following up until the payment posts.
- Knowledge
- Payer rules and claim history
- Guardrail
- Stays within the approved scope
Fix and resubmit
Corrects the claim and sends it back through the clearinghouse.
- Knowledge
- Your EHR / EMR and practice management data
- Guardrail
- Every change stays on record
Human review
Approves the judgment calls and takes every escalation.
- Brought in
- Above your threshold
- Escalation
- When an agent is unsure
Payer codes the agents read Sample
- DenialCO-16N286
- CPT99214
- ICDI10
- CoverageOffice visit, in network
Guardrails
Guardrails and knowledge,
Guardrails and knowledge,
yours and ours.
Before we go live, we set the rules with your team: what each agent may do, when it must stop and bring your team in, and who approves a judgment call. The agents draw on Tago Health’s knowledge of payer rules, denial codes and appeal playbooks, and on your own contracts, fee schedules and playbooks.
Guardrails
- What an agent may doRead the denial, draft the appeal, fix the claim, and call the payer.
- When it must stopThe reason is unclear, or a call leaves the approved scope. It escalates to your team.
- Who approvesApproval required above a threshold you set, before anything goes out.
Knowledge
- Tago Health, ready nowPayer rules, denial codes, and appeal playbooks.
- Yours, added inContracts, fee schedules, and playbooks.
- Both, on every stepEach agent draws on Tago Health’s knowledge and yours together.
Go live
Checked with your team,
Checked with your team,
then live.
We connect to your EHR / EMR, practice management system, clearinghouse and payer portals. We run the flow on sample claims with your team, then go live. Every step and every decision stays on record.
Library
Start with the work
Start with the work
that needs chasing.
Denials, follow-up, underpayments, and aged A/R. We set each flow up with your rules and go live.
Work the denial
Understand it, then appeal it, call the payer, or fix and resubmit, with your team approving.
- Reason read
- Your team approves
- Followed until paid
Get an answer
Find claims with no response and carry them through to a next action.
- Status checked
- Portal or payer call
- Next action set
Check the payment
Compare what the payer paid with the expected amount.
- Contract or fee schedule
- Adjustments accounted for
- Variances taken up
Work the backlog
Work the backlog before recoverable claims run out of time.
- Deadlines checked
- Ordered by deadline and value
- Followed to closure
Questions
Yes. We set it up
Yes. We set it up
and go live.
Can we use the platform?
Yes. We set it up with your rules, your guardrails and your knowledge, and go live. Your team approves the judgment calls from day one.
What do we decide?
What an agent may do, when it must stop and bring your team in, and who approves a judgment call. We set those up with you, using Tago Health’s knowledge and yours.
Where do we start?
Start with denials. The Understand agent reads each one, the right agent appeals it, calls the payer, or fixes and resubmits it, and your team approves before anything goes out.
Start with your denials.
Shape the rest with us.
Tell us which claims to work first. We’ll set the workflow up with your rules, your guardrails and your knowledge.