For software and AI teams

Current reimbursement logic, one API away.

Give your systems and agents current coverage, PA, coding, documentation, and rate logic over the API, MCP, or a custom integration, without maintaining any of it by hand.

AI agents & co-pilots

Agents grounded in yourreimbursement logic.

Your agents should not guess from PDFs. They should act from approved reimbursement logic: the same policy, contract, and billing rules your team controls in Converus.

01 We build agents for your workflows

Co-pilots for prior auth, appeals, coding, claim scrubbing, and payer-requirement capture, each one acting from the rule layer your team reviews and approves.

  • Prior auth co-pilotchecks payer criteria, identifies missing evidence, prepares submission
  • Appeals co-pilotfinds the policy or contract term behind a denial, drafts a grounded appeal
  • Coding co-pilotmaps test, indication, diagnosis, payer, and documentation to coding logic
  • Claim scrubbingflags PA, documentation, coding, and contract issues before claims go out
  • Custom capturecaptures payer requirements from portals, calls, and operational workflows

02 Your agents read your data and logic

Already building your own? Connect them through MCP or the API and they query your current policies, contracts, and billing rules, cited and always current.

PA Submission Appeal Agent Denial Triage Claim Scrubbing Coverage Lookup Policy Sync Converus MCP · policy intelligence
Use cases
Billing system rulescurrent payer logic pushed straight into your billing system
Prior auth checkswhether PA applies and exactly what evidence it needs
Claim scrubbingcatch PA, coding, and contract issues before submission
Denial routing & appealstrace a denial to its source and draft the appeal
Coding supportmap test, diagnosis, and payer to coding logic
Internal AI agentsground your own tools in approved reimbursement rules
Custom payer workflowsencode the quirks specific to each payer

Turn payer policy into logicyour systems can execute.

A 30-minute walkthrough with your codes, your payers, and the policies behind last quarter's denials.

Book a demo