> ## Documentation Index
> Fetch the complete documentation index at: https://docs.medera.info/llms.txt
> Use this file to discover all available pages before exploring further.

# Claims Review Agent

> Pre-submission claim scrubbing and edit checks.

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<Info>
  **Category:** Revenue Cycle & Operations  ·  **Signals:** Claim line items · Payer edit rules · Modifier logic · NCCI edits
</Info>

Catch claim errors before they leave the practice — surface fix suggestions, not just rejections.

## Configuration

| Field               | Description                      |
| :------------------ | :------------------------------- |
| `payer_edits`       | Payer edit rule library          |
| `ncci`              | NCCI edit set                    |
| `modifier_policy`   | Modifier policy                  |
| `approval_workflow` | Pre-submission approval workflow |

## Execution

1. Reads the claim before submission
2. Runs payer edit rules and NCCI edits
3. Validates modifier and code-pair logic
4. Surfaces errors with rationale and fix suggestions
5. Routes to billing for approval and submission

## Composable experts

| Expert                     | Role                               |
| :------------------------- | :--------------------------------- |
| **Payer Edit Rule Expert** | Carrier-specific edits             |
| **NCCI Edit Expert**       | National Correct Coding Initiative |
| **Modifier Expert**        | Modifier logic + validation        |
| **Claim Structure Expert** | Line item + total validation       |

## Compliance guarantees

<Warning>
  * Every edit failure is reported with a rationale

  * Fix suggestions are surfaced, not auto-applied

  * Submission requires explicit billing approval
</Warning>

## Endpoints

Backend: `POST /api/billing/claims/scrub` · `POST /api/billing/claims/submit`.

***

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