Claude to reconcile medical reimbursement claims

An author who submitted out-of-network medical bills for themselves and their wife had lost track of what Aetna had received, allowed and paid. They gave Claude Cowork invoices, explanation-of-benefits documents and the plan's schedule of benefits, then developed a reimbursement workbook.

The workbook matched three sides of each claim: the provider invoice, the submitted claim and the insurer's response. Service dates and procedure codes helped connect records. Separate sheets held claims, invoices and an action dashboard, with live formulas rather than only a written summary. In-network records were separated, ambiguous matches remained in an inbox and duplicate records were excluded.

The author reports more than $8,000 in flagged errors within twenty-four hours. That is money questioned, not money recovered. Examples included a denial citing a daily visit limit for sessions a month apart, documentation already supplied, and conflicting statements about whether payment had gone to the provider.

The follow-up explains the operating boundary. A Friday report is read-only and distinguishes items waiting on the patient, insurer or provider. Changes require manual application, and the author submits material through the insurer portal. A claim marked acceptable can still have no reimbursement because of the deductible; the system therefore does not treat an apparently valid claim as proof of payment.

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Source: www.reddit.com · u/No_Zookeepergame8576