Invoice Extraction Agent
Extract and validate hospital invoice data for structured, claim-ready outputs with IPD codes
Description
Challenge:
Hospital invoices are often unstructured, multi-page, and vary widely in format. Fields such as patient details, provider information, event dates, and line-item charges may appear inconsistently across pages. Manual review risks missing critical information, misclassifying expenses, incorrectly assigning IPD codes, and causing compliance gaps. These challenges slow claim adjudication, increase operational workload, and can lead to disputes with providers. Automation is required to ensure complete, validated, and standardized invoice data for efficient claims processing.
How It Works:
The Invoice Extraction Agent ingests hospital invoices in any format (scanned, PDF, or digital). It extracts structured header, patient, provider, event, doctor, and line-item data page-by-page. Each line item is categorized and mapped to standardized IPD codes using semantic vector search. The agent validates invoice type, mandatory fields, numeric totals, discounts, and currency. Any missing or inconsistent entries are flagged for manual review. Structured, validated JSON outputs are then delivered to claim adjudication, billing, or policy systems, ensuring accuracy, compliance, and audit readiness.
Benefits:
Achieves 90–95% accuracy in extracting structured invoice fields.
Ensures 100% compliance in invoice type validation.
Successfully maps 85–90% of line items to IPD codes using semantic vector matching.
Reduces manual invoice processing time by 60–70%.
Provides ready-to-ingest, audit-ready JSON for claims adjudication.
Resources
Features
Automates the extraction, validation, and categorization of hospital invoice data, ensuring every invoice is complete, compliant, and enriched with standardized IPD codes.
Features & Capabilities:
Document Ingestion: Accept scanned, PDF, or digital invoices, including multi-page files.
Header & Event Extraction: Extract hospital, patient, payor, and admission/discharge/consultation dates.
Line-item Parsing: Capture descriptions, quantities, amounts, and subtotals.
IPD Categorization & Mapping: Assign standardized IPD codes to line items using semantic vector search.
Doctor Extraction: Deduplicate and classify doctors by specialization and type (GENERAL/SPECIALIST, GP).
Validation Checks: Verify invoice type, totals, discounts, mandatory fields, and currency.
Structured Output: Produce page-wise JSON adhering to strict schema.
Audit Logging: Record extraction decisions, validations, and IPD assignments for compliance.
Operating Blueprint
Knowledge Sources:
Hospital invoice documents (multi-page, non-template).
Policy and claims validation rules.
IPD code reference mapping.
Provider directory for hospital validation.
Regulatory guidance on acceptable invoice types and compliance.
Business Rules:
Invoice Type Rule: Only “Final Invoice” accepted; “Temporary,” “Copy,” or “Duplicate” marked invalid.
Mandatory Fields Rule: Hospital name, patient name, admission & discharge dates, and total amount must be present.
IPD Mapping Rule: Each line item must map to a valid IPD code; unmatched items flagged.
Totals & Discount Validation: Grand total must equal subtotal minus discounts; discrepancies flagged.
Doctor Classification Rule: Default missing specialization to “GENERAL” and type to “GP.”
Currency Rule: Default to IDR if missing; validate if differing currency.
Tool Workflow:
Receive invoice (scanned/PDF/digital).
Extract headers, patient, payor, event, and doctor details.
Parse all line items with descriptions, quantities, and amounts.
Assign IPD codes using semantic vector search.
Apply validation rules for invoice type, mandatory fields, totals, discounts, and currency.
Compile structured JSON output per page.
Log audit trail for all extraction, mapping, and validation decisions.
Badges
Classification
Capabilities
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