MediClaim Pilot

AI-powered medical bill auditor that catches billing errors and fights insurance denials.

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Inspiration

What it does MediClaimPilot is a 6-agent AI pipeline that audits medical bills and fights health insurance denials. Upload any medical bill or denial letter — the system reads every CPT code, cross-references CMS federal coding rules, detects billing errors (duplicate charges, NCCI bundling violations, phantom charges, upcoding), calculates the exact overcharge, and instantly generates legally-grounded dispute letters citing real federal law.

Tested on a real bill from Princeton Radiology Associates: detected 2 billing errors totaling $508 in overcharges — in under 60 seconds.

How we built it- with help of Claude

Challenges we ran into- The Gemini API free tier had quota=0 for gemini-2.0-flash and gemini-1.5-flash was removed from the API entirely. Had to query the ListModels endpoint directly to find gemini-flash-latest as the working model. Vercel also buffers SSE by default — fixed with X-Accel-Buffering: no header.

Accomplishments that we're proud of - The system correctly identified a real NCCI bundling violation on an actual patient's radiology bill — CPT 76817 billed with CPT 76801 on the same date without Modifier 59 — and generated a dispute letter citing the exact CMS NCCI Policy Manual chapter. This is a real finding on a real bill that could recover $508 for a real patient.

What we learned- There are many problems which can be solved in future now with help of the agent.

What's next for - EOB (Explanation of Benefits) upload support, insurance denial appeal letters, deadline tracking dashboard, and expansion to Medicare/Medicaid billing disputes.

The Change it brought as soon as 2 days =

"Patient disputed bill → received response same day → balance reduced from $282.49 to $183.93." Screenshots attached, updated next section.

Built With

  • claude-code
  • events
  • google-gemini-flash-ai
  • next.js-14
  • server-sent
  • supabase
  • tailwind-css
  • typescript
  • vercel
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