Health

Invoice Checking Agent

Weeks after the invoice goes out, the health insurance fund queries it, and nobody remembers why. The case is reopened from scratch.

Checks hospital invoices automatically for completeness and plausibility.

Open agent
Public administration

Four processes that take up the most time today

Developed in Germany · Hosted in the EU

Developed in Germany · Hosted in the EU or on-premises

Delivered together with

STACKIT Sovereign hosting in Germany, single-tenant from the first user.
Rödl Legal, tax and compliance expertise for legally sound deployment.
4P Consulting Advisory and implementation for the public sector, starting with the AI readiness assessment.

Every query from the health insurance fund costs more than checking the rules before the invoice goes out.

The case is coded, the DRG is determined and the invoice goes out. When a query arrives weeks later, someone has to piece together the file, the coding and the rule as they stood at the time. Until the answer is ready, the amount stays outstanding.

1caseAn inpatient case is coded and invoiced to the health insurance fund.
18checking rulesPrincipal and secondary diagnoses, length of stay and supplementary fees are checked against the rules.
6weeksThat is how long the case sits before the fund's query arrives.
2passesThe file is read a second time, this time without the original context.

There is no second pass six weeks later if the 18 rules are applied before the invoice goes out, and that is where the 40 to 60% less review effort comes from.

The 40 to 60% reduction in checking effort is this agent's headline figure. The number of rules, the waiting time and the second pass describe a typical query case in hospital billing; they are illustrative, not measured.

Three steps through the process.

The agent checks coding and procedure codes against the rulebook and records every checking step; it does not rule on the coding itself.

Check the codes against the rulebook

The agent reads the case's principal and secondary diagnoses, procedures and supplementary fees and checks them against the stored rules. Every finding is tagged with the rule and where it appears in the file.

Case DRG-2026-11274, 18 rules applied, 2 hits

Back up the coding from the file

For every coded secondary diagnosis, the agent looks for the documented evidence in the progress notes. If the evidence is missing, it flags the code rather than deleting it.

Secondary diagnosis J44.19 with no entry in the progress notes, flagged with page reference

Attach the checking note to the case

The agent attaches a note with rules, source references and open points to the case. Correction and dispatch rest with the hospital billing specialist.

abrechnungsnotiz_DRG-2026-11274.pdf, 18 checkpoints, 2 open

What the agent does not do.

It does not change any coding.

It flags the code and names the rule behind it. The hospital billing specialist changes it.

It does not send invoices.

It attaches the note to the case. Approval and dispatch rest with billing coordination.

It does not answer queries from the health insurance fund.

It compiles the source references for the case. The specialist drafts and signs the reply to the fund.

Connected systems

  • Hospital information system
  • billing system
  • DRG grouper

Operations

  • Deployment modelEU cloud, private cloud or on-premises
  • Data processingGDPR-compliant, no model training on your data
  • Responsible teamsBilling, controlling

The questions that come up before the first meeting.

How quickly is the Invoice Checking Agent ready to use?

A pilot typically runs on your own data within 4 to 6 weeks. The agent connects to your existing systems rather than running as a separate, parallel environment.

Where is the data processed?

EU cloud, private cloud or on-premises. Processing is GDPR-compliant and models are never trained on your data. Details in the Trust Center.

Where does the figure “40 to 60% less review effort” come from?

It is based on experience from comparable projects and process benchmarks, not a commitment. We work out the realistic effect for your organisation during the assessment before the pilot.

Related agents.

Intake review, case 2026/04711

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