BrainSAIT Agents in Healthcare¶

Overview¶

BrainSAIT's healthcare agents form an intelligent ecosystem designed to automate and optimize healthcare operations in Saudi Arabia.

ClaimLinc¶

Purpose: Intelligent Claim Validation and Rejection Analysis

Capabilities¶

• Pre-submission validation against NPHIES rules
• Rejection reason interpretation in natural language
• Financial impact calculation (SAR loss estimation)
• Resubmission recommendations with step-by-step guidance
• Pattern detection across claim batches

Technical Architecture¶

# AGENT: ClaimLinc system architecture
# MEDICAL: FHIR R4 validation
# NEURAL: LLM-powered analysis

class ClaimLinc:
    """
    Intelligent claim validation and rejection analysis

    BRAINSAIT: Full audit logging
    """

    async def validate_claim(self, claim: Claim) -> ValidationResult:
        """
        Comprehensive claim validation

        Args:
            claim: FHIR Claim resource

        Returns:
            Validation result with specific issues

        MEDICAL: Multi-layer validation
        """
        results = []

        # Layer 1: FHIR schema validation
        schema_result = self.validator.validate_schema(claim)
        results.append(schema_result)

        # Layer 2: NPHIES profile compliance
        profile_result = self.validator.validate_nphies_profile(claim)
        results.append(profile_result)

        # Layer 3: Payer-specific rules
        payer_result = await self.knowledge_base.validate_payer_rules(
            claim=claim,
            payer_id=claim.insurer.identifier.value
        )
        results.append(payer_result)

        return ValidationResult(results)

Key Performance Indicators¶

PolicyLinc¶

Purpose: Payer Policy Intelligence

Capabilities¶

• Reads and interprets payer policy PDFs
• Summarizes coverage rules
• Matches policy rules against claims
• Identifies coverage gaps
• Provides clinical justification templates

Use Cases¶

1. Policy Analysis: Extract structured rules from unstructured policy documents
2. Coverage Verification: Real-time benefit confirmation
3. Prior Authorization: Automated PA requirement detection
4. Denial Prevention: Proactive policy compliance checking

DocsLinc¶

Purpose: Medical Document Processing

Capabilities¶

• Extracts medical information from clinical notes
• Converts handwritten prescriptions to digital format
• Reads and structures doctor's notes
• Converts PDFs to structured FHIR data
• Validates documentation completeness

Supported Document Types¶

• Clinical notes
• Discharge summaries
• Lab reports
• Radiology reports
• Prescriptions
• Referral letters

RadioLinc¶

Purpose: Diagnostic Image Analysis

Capabilities¶

• X-Ray interpretation
• CT scan analysis
• MRI review
• Triage scoring
• Abnormality detection
• Report generation

Clinical Applications¶

• Emergency department triage
• Radiology workflow optimization
• Second opinion validation
• Quality assurance

Voice2Care¶

Purpose: Patient Interaction Automation

Capabilities¶

• Auto-triage voice agent
• Appointment scheduling
• Consultation support
• Symptom assessment
• Medication reminders
• Follow-up coordination

Features¶

• Bilingual: Arabic and English support
• 24/7 Availability: Always-on patient support
• HIPAA Compliant: Secure voice processing
• Integration: Connects with EMR systems

Agent Orchestration¶

MasterLinc Coordination¶

workflow:
  patient_registration:
    - Voice2Care: Collect patient information
    - PolicyLinc: Verify insurance eligibility
    - DocsLinc: Process insurance documents

  clinical_encounter:
    - DocsLinc: Extract clinical notes
    - RadioLinc: Analyze diagnostic images
    - ClaimLinc: Validate claim data

  claim_submission:
    - ClaimLinc: Pre-submission validation
    - PolicyLinc: Policy compliance check
    - ClaimLinc: Submit to NPHIES

  rejection_handling:
    - ClaimLinc: Analyze rejection reason
    - PolicyLinc: Review policy requirements
    - DocsLinc: Identify missing documentation
    - ClaimLinc: Generate resubmission package

Integration Guide¶

API Access¶

from brainsait.agents import ClaimLinc, PolicyLinc, DocsLinc

# Initialize agents
claim_agent = ClaimLinc(api_key=os.getenv("BRAINSAIT_API_KEY"))
policy_agent = PolicyLinc(api_key=os.getenv("BRAINSAIT_API_KEY"))

# Validate claim
validation_result = await claim_agent.validate_claim(claim_data)

if not validation_result.is_valid:
    # Get policy guidance
    policy_guidance = await policy_agent.get_coverage_rules(
        payer_id=claim_data.payer_id,
        service_codes=claim_data.service_codes
    )

    print(f"Validation errors: {validation_result.errors}")
    print(f"Policy guidance: {policy_guidance}")

Related Documentation¶

• NPHIES Integration
• Claims Lifecycle
• Technical Architecture