MVP V1 – Denial Prevention Copilot
AI-powered claim review, policy intelligence, and denial risk mitigation for revenue cycle teams.
This MVP demonstrates a governance-first architecture combining deterministic healthcare claim validation with citation-grounded AI review.
Key capabilities:
- NPI validation
- NCCI edit detection
- MUE validation
- ICD-10 validation
- HCPCS validation
- Modifier validation
- Coverage Review Agent
- Coding Review Agent
- Citation-grounded findings
- Supporting Policies Reviewed
- Deterministic risk synthesis
- Human review workflow
- Audit trail
- Golden set evaluation framework
- Streamlit Cloud deployment hardening
- Self-healing audit database initialization
- Graceful ChromaDB fallback behavior
- Live CMS rule-layer support using maintainer-managed GitHub Release Assets
Highlights:
- 549+ automated tests passing
- Rule Engine + AI architecture
- CMS policy retrieval and grounding
- Explainable findings and recommendations
- Synthetic data only (no PHI)
This project is intended for educational and portfolio demonstration purposes and is not intended for clinical or production use.