International Journal of Computer
Trends and Technology

Research Article | Open Access | Download PDF

Volume 73 | Issue 6 | Year 2025 | Article Id. IJCTT-V73I6P111 | DOI : https://doi.org/10.14445/22312803/IJCTT-V73I6P111

Intelligent Agents for Healthcare Complaint Management: Ensuring Compliance with HIPAA and Medicare Standards

Shrikanth Mahale

Received Revised Accepted Published
01 May 2025 02 Jun 2025 20 Jun 2025 30 Jun 2025

Citation :

Shrikanth Mahale, "Intelligent Agents for Healthcare Complaint Management: Ensuring Compliance with HIPAA and Medicare Standards," International Journal of Computer Trends and Technology (IJCTT), vol. 73, no. 6, pp. 89-96, 2025. Crossref, https://doi.org/10.14445/22312803/IJCTT-V73I6P111

Abstract

Healthcare is just one of several industries that could utilize IAs to enhance productivity, improve care, and keep healthcare organizations within regulations. This is particularly true of health care-related events, such as concerns about HIPAA compliance or Medicare. We discuss these topics in this little article related to smart agents in healthcare complaint management systems, meeting Medicare and HIPAA standards, and solving patient issues. Processing complaints and extracting valuable information from humongous data sets through MWI can be automated by incorporating AI, ML, and advanced automation into IAs. This also accelerates the procedure and increases resolution. With the help of AI-based agents in complaint handling, the healthcare sector has experienced better response time, accuracy, and overall customer experience (CX). Another way they might be useful is to ensure that all data storage complies with HIPAA privacy regulations. They boast that they employ super-duper algorithms to mine complaints data, spot trends, and issue advice to prevent future gaffes. An AI machine, in theory, might be able to figure out why Medicare paid out on some claims, while others were underpaid, by looking at the two data sets. Organizations involved in healthcare delivery can improve operational productivity through the management of complaints. This is because it allows workers to focus on more crucial issues instead of having to carry out repetitive low-level tasks that can be automated by machine learning. In addition to helping meet the evolving standards of HIPAA and Medicare, smart agents enable healthcare providers to cut administrative costs associated with compliance. Intelligent agents give rise to a variety of challenges, as described in the paper.

Keywords

Intelligent Agents, Managing Healthcare Complaints, HIPAA Compliant, Medicare Guidelines.

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