aws-samples/sample-healthcare-agents

appeals

Use when a provider needs to generate an appeal letter for a denied insurance claim, check filing deadlines, validate appeal components, or save completed appeal letters to S3 with presigned download URLs.

claims-assembly

Use when a provider needs to validate claim data and assemble an EDI 837P professional claim, check payer-specific validation rules, or verify HIPAA 5010 compliance before submission.

claims-submission

Use when a provider needs to submit an assembled EDI 837P claim to a payer via AWS B2B Data Interchange, track submission status, or check for acknowledgment responses (997/999 and 277CA).

eligibility-verification

Use when a provider needs to verify patient insurance eligibility, check active coverage status, determine benefits and cost sharing (copay, coinsurance, deductible), or assess whether a service requires prior authorization.

medical-coding

Use when a provider needs to find ICD-10-CM, CPT, or SNOMED CT codes for diagnoses and procedures, extract medical entities from clinical text using Comprehend Medical, or validate code accuracy against clinical documentation.

prior-authorization

Use when a provider needs to submit a prior authorization request, check if a procedure requires prior auth, gather clinical evidence from HealthLake, assess medical necessity against payor criteria, or generate FHIR Da Vinci PAS Bundles and ClaimResponses.