RCAI Agent Blueprint Library

Build revenue cycle AI agents from an operating specification—not a prompt.

RCAI blueprints translate real RCM workflows into implementation architecture: states, data contracts, tools, decision policies, exceptions, human controls, KPIs and evaluation plans.

Two complete blueprints are open. The full implementation library is included with RevCycleAI Pro. No separate blueprint purchases or request forms.
FREE
01 · CLAIMS

Claim Status & A/R Follow-Up

Determine claim disposition, select the next safe action and route exceptions without unnecessary touches.

276/277Portal/APIState machineHITL
  • Submitted → accepted → pending → paid/partial/denied
  • Processing-window, retry and escalation logic
  • 100-scenario evaluation plan
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FREE
02 · PATIENT ACCESS

Eligibility Verification

Turn payer eligibility responses into normalized, actionable registration and financial-clearance data.

270/271BenefitsCOBConfidence
  • Member and demographic validation
  • Benefit extraction and source precedence
  • Conflicting-source and exception escalation
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PRO
03 · DENIALS

Denial Classification & Appeal

Classify denials, determine recoverability and select the correct resolution or appeal path.

CARC/RARCRoot causeAppeals
  • Denial taxonomy and routing
  • Documentation and timely-filing controls
  • Evaluation and production acceptance criteria
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PRO
04 · PAYMENT

Underpayment Detection

Compare expected reimbursement with actual payment and prioritize actionable contract variance.

835/ERAContractsVariance
  • Expected-vs-paid calculation
  • Materiality and confidence thresholds
  • Recovery and exception queues
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PRO
05 · PATIENT ACCESS

Prior Authorization

Determine requirements, assemble evidence, track payer status and escalate before service.

Payer rulesClinical inputsDeadlines
  • Requirement determination
  • Submission and missing-information states
  • Approval, denial and expiration monitoring
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RCAI Blueprint Standard

Every blueprint uses the same implementation framework.

Agent contractObjective, scope, trigger, inputs, outputs and system of record.
State machineTransitions, retries, terminal states, timeouts and recovery.
Tool & data layerEDI/API/portal/PMS interfaces, schemas and source precedence.
Decision policyDeterministic rules, model reasoning and autonomy boundaries.
Human controlsHITL triggers, approvals, escalation, PHI and audit evidence.
EvaluationGolden/adversarial cases, KPIs, regression and go-live thresholds.
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