Sec 01 · OverviewManaged AI Agent Operations · Healthcare
Your healthcare AI agents,
run like production systems.
Nestack Agent Care operates the AI agents behind your patient access, revenue cycle, and payer compliance. We watch every run, from scheduling and eligibility to prior authorisation and appeals, so a wrong benefit answer or a miscoded claim is caught before it reaches a patient or a payer.
- Failure modes catalogued
- 137
- Agent playbooks
- 12
- Enterprise critical SLA
- 30 min
- Continuous agent operations
- 24/7
PlaybooksSection 02
Pick your agent
Choose from 12 healthcare agent playbooks to see what each agent does, where it can fail, and how we keep it reliable, compliant, secure, and production-ready.
Check whether an order needs authorisation, assemble the clinical packet, submit and track it, and propose codes with the documentation behind them — the payer decides coverage, a certified coder signs the code.
Open Prior-authorization & claims-coding agents7 failure modes
Give a representative the benefit, claim and cost-share answer with the governing document cited beside it, and capture grievances and appeals to the clock — adverse determinations stay with qualified staff.
Open Member-services copilots7 failure modes
Book, reschedule and sequence visits against your provider templates, chase what each visit needs and close the referral loop — with clinical urgency and every care-plan change kept with a clinician.
Open Appointment & care-coordination agents7 failure modes
Read remittance advice, classify why each claim denied, assemble the appeal with its supporting record and work aged AR by payer — with deadline tracking, audit trails and a person signing every appeal and write-off.
Open Denials-management & AR-follow-up agents7 failure modes
Locate the criteria that apply, find where the submitted record speaks to each one, and hand a nurse reviewer or medical director a structured summary — the reviewer decides, and the agent never denies.
Open Utilization-management & medical-necessity review agents7 failure modes
Read the retrieved chart against each submitted diagnosis, show what it supports and what it does not, and propose additions and deletions, encounter attached, for a certified coder to accept.
Open Risk-adjustment & RADV audit-defence agents7 failure modes
Assemble the expected items for a scheduled encounter, price them against the chargemaster and coverage, draft the required estimate, and screen for financial assistance before a counsellor releases it.
Open Patient price-estimate & financial-clearance agents7 failure modes
Run the coverage check, read the response into the fields registration needs, propose the payer sequence, search self-pay patients for undisclosed coverage, and flag what will deny — a registrar accepts each result.
Open Eligibility & benefits-verification agents7 failure modes
Read the chart after the encounter, surface the indicators that make it ambiguous, and draft a query in the health system's own templates for the treating clinician to answer — or not.
Open Clinical-documentation-integrity (CDI) query agents7 failure modes
Classify each case against CMS criteria, start the right clock, assemble the evidence a reviewer needs, and draft the resolution and its notice — a qualified reviewer decides, a clinician decides anything clinical.
Open Appeals & grievances agents (health plan)7 failure modes
Assemble the credentialing file, run what the primary source can confirm, keep re-credentialing and expirable dates ahead of schedule, prepare payer enrolment and roster submissions, and reconcile the directory — the governing body decides.
Open Credentialing & provider-directory agents7 failure modes
Model what the contract said a paid claim should pay, read the remittance for what actually happened, explain each variance against the contract term behind it, and assemble the dispute a contract manager releases.
Open Underpayment-recovery & contract-compliance agents7 failure modes
Regulatory map
The rules your healthcare agents answer to
Every failure mode in the Healthcare playbook is mapped to the rule it could breach. These are the 16 regulatory areas we watch, each with its citation.
- 01HIPAA Privacy Rule & business associates (US)45 CFR 164.502(e) · 164.504(e) · 164.502(b)(1)5 failure modes
- 02HIPAA Security Rule & breach notification (US)45 CFR 164.312 · 45 CFR 164.4046 failure modes
- 03FDA device boundary (US)21 U.S.C. 360j(o)(1)(E) · FDA CDS Guidance (FDA-2017-D-6569)5 failure modes
- 04Medicare Advantage coverage & utilization management (US)42 CFR 422.101 · 422.137 · 422.562(a)(4)8 failure modes
- 05False Claims Act, overpayments & risk adjustment (US)31 U.S.C. 3729(a)(1)(G) · 42 CFR 422.326 · 422.504(l)9 failure modes
- 06Record authentication & authorship (US)42 CFR 482.24(c)(1) · 482.12(c)(1) · PIM 100-08 ch. 3 §3.3.2.1.16 failure modes
Sec 03 · Procedures
Onboard → Observe → Respond → Improve → Verify
We instrument your agents, watch them around the clock, turn incidents into fixes, verify that improvements hold, and deliver a monthly audit-ready scorecard your board or regulator can read.
When an agent misbehaves, nobody improvises — the crew flies the procedure.
Agent incident response
Applies: SEV-1 / SEV-2 / SEV-3
DetectEP-1
An alert, failed evaluation, guardrail event or human reviewer identifies a risky session. The case is acknowledged according to the applicable response target.
ContainEP-2Memory item
For a SEV-1 incident, pause the affected workflow, restrict the risky tool or move the agent into an agreed safe mode before full diagnosis. Containment authority is established during onboarding.
DiagnoseEP-3
Correlate the goal, retrieval, plan, workflow, task, tool, LLM, evaluation and guardrail records; identify the affected slice, classify the failure mode, and locate the earliest critical decision that caused the issue.
RemediateEP-4
Apply the relevant runbook and correct the affected prompt, workflow, tool configuration, data source or guardrail. Link the change to the originating evidence and verify the affected slice through targeted output, step or trajectory evaluations before restoring autonomy.
NotifyEP-5
Notify the client according to the agreed communication target. SEV-1 updates include affected agents, impacted sessions, containment status, probable source and next action.
LearnEP-6
Complete the post-incident review within five business days. Close the incident only after the failure mode, corrective action and verification evidence are recorded, and the relevant evaluation case, guardrail or runbook has been updated.
Nestack Agent Care contains the immediate risk, identifies the failed operational layer, verifies the corrective action, and converts the incident into reusable evidence for future monitoring and evaluation.
AI Agent Care pricing, made simple
Per agent. Per month. Pay only for the AI agents actively running in production.
Agent Care
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