AWS reference architectureClaims preparation, scrubbing, and denial management
A AWS reference architecture for claims preparation, scrubbing, and denial management in Healthcare. Triggered by encounter coded and ready to bill, Padiso orchestrates 3 specialist agents on Amazon Bedrock AgentCore, reaching practice management / billing and your tools through the Model Context Protocol, with budgets, approvals and an audit trail throughout.
AWSRuntime: Amazon Bedrock AgentCoreTrigger
Encounter coded and ready to bill
Healthcare
Orchestration
Padiso Orchestrator
goals · tasks · heartbeat
Governance
budgets · approvals · audit
Runtime & agents
Agent runtime
Amazon Bedrock AgentCore
Intake coordinator
agent
Claims & billing agent
agent
Scheduling agent
agent
Integrations · MCP
MCP gateway
Your systems
Practice management / billing
Clearinghouse (837/835 EDI)
Coding rules engine
How the data flows
Trigger: Encounter coded and ready to bill
- 1
Claims agent assembles the 837, validates ICD-10 / CPT codes and scrubs for errors
- 2
Submission agent routes the claim through your clearinghouse and tracks acknowledgements
- 3
On an 835 denial, a denial agent classifies the reason and drafts the correction or appeal
- 4
High-dollar or repeat denials escalate to a biller with full context
Agent team
- Intake coordinator
- Claims & billing agent
- Scheduling agent
Integrations
Reached through the Model Context Protocol, scoped and governed.
Runtime & data
Amazon Bedrock AgentCore
Practice management / billing
Clearinghouse (837/835 EDI)
Coding rules engine
Security & operational considerations
- Every claim action logged for payer audits
- Per-payer scrub rules, versioned
- Approvals required on write-offs and adjustments
AWS deployment
Deployed in your AWS account on Bedrock AgentCore, with IAM scoping, PrivateLink to your VPC, and CloudTrail/CloudWatch for audit and observability.
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