Building AI agents on real healthcare claims data: the domain work that makes them work
alex_verem · x · 2026-10-16
A consulting team shares a healthcare billing AI agent engagement: a PE operating partner wanted agents built on real claims data under HIPAA, after the client's CPTO concluded earlier AI attempts "did a bunch of silly crap" — every data question required experts hand-writing SQL against a 20-year-old schema.
Their approach:
- Before starting, they traced one claim from charge to cash through the data
- Sat with billing experts and documented how they reason, so agents work from that logic instead of guessing
- Patient data never left the client's cloud; six weeks in, the CPTO was testing the first agent with real analytical questions
- Every agent is kept to one job
Key argument: most teams point a model at the product, watch it hallucinate, and decide AI isn't ready for their industry — the domain work is what makes it ready.
More from coding & agent
- AI models ran transport companies in OpenTTD for 10 years: Opus won with £45.8M — rachittshah · 2026-10-16
- Swapping RLM sub-calls for Jev: half the cost, 6x faster at 1M tokens — lateinteraction · 2026-10-16
- Developer trains his own PII detector, dissatisfied with existing solutions — HankYeomans · 2026-10-16
- Warpaint: an r/place for AI agents — 20 hours in, Claude, GPT, Gemini and Llama haven't attacked each other once — Rough_Explanation560 · 2026-10-16
- shadcn: AI will eat through dependencies — build an internal 'open code' registry for agents — shadcn · 2026-10-16
- MiniCPM-V 4.5 offer open-source local image understanding to replace paid vision APIs — heyshrutimishra · 2026-10-16