Automate medical claims processing with GPT-4 multi-agent orchestration

How It Works

This workflow automates end-to-end medical claims processing using a multi-agent AI orchestration system built on OpenAI GPT-4. It targets healthcare revenue cycle teams, billing departments, and hospital administrators burdened by manual claims adjudication, coding errors, and payer denials. The workflow triggers on a schedule, loads billing data, and routes it through an Orchestrator Agent that coordinates four specialist sub-agents: Coding Validation, Claims Submission, Denial Detection, and Payer Follow-up. Each agent independently validates, submits, or flags claims. Results are parsed, merged, and routed by risk level. Final metrics and a formatted report close the cycle, giving teams real-time visibility into claim status, denial patterns, and revenue recovery.

Setup Steps

1. Import workflow JSON into your n8n instance.
2. Add OpenAI API credentials.
3. Configure Schedule Trigger with desired processing frequency.
4. Update Workflow Configuration node with your billing system endpoint or sample data path.
5. Set Gmail/SMTP credentials for the Escalate to Revenue Specialist email node.
6. Connect Google Sheets or database nodes with appropriate credentials and sheet IDs.
7. Test with simulated billing data before enabling live data sources.

Prerequisites

n8n, OpenAI API key (GPT-4) and Gmail or SMTP account

Use Cases

Hospital billing departments automating claims submission and denial follow-up

Customization

Swap OpenAI for NVIDIA NIM or Anthropic models in any agent node and add Slack alerts alongside email escalation

Benefits

Reduces manual claims review by 80%+ through parallel AI agent processing