An example of medical coding and RCM as a governed process: agents do the 7 steps, and a person signs the gate before anything irreversible happens. Download it, import it into your workspace, and adapt it to your systems.
minctrl.process/v1 · hash d50d0aaf1b8e…594e
Manual medical coding is slow, expensive, and error-prone; miscoding drives denials and False-Claims-Act exposure. Clean claims submitted straight-through; risky claims escalated to a certified coder; denials and overpayments handled.
A submitted claim is an attestation to a payer with False Claims Act exposure, so a certified coder signs off on ambiguous or high-value coding before the claim is released.
| Rule | What it requires |
|---|---|
| HIPAA Privacy, Security & Transactions | PHI must be minimum-necessary, access-controlled and audit-logged, and claims ride the HIPAA-standard X12 transactions (e.g. 837 claim, 835 remittance). |
| ICD-10-CM/PCS & CPT/HCPCS coding accuracy | Diagnoses and procedures must be coded per official ICD-10 and CPT/HCPCS guidelines and supported by the clinical documentation; the code drives the claim and the reimbursement. |
| False Claims Act / no upcoding | Submitting a claim to a federal payer that isn't supported by documentation (upcoding or unbundling) creates False Claims Act exposure, so coding accuracy is a compliance matter, not just a revenue one. |
A summary for orientation, not legal advice.
A minctrl.process/v1 document: the graph and the hash of the process it becomes.
Import into Minctrl opens this example in your workspace; one click stores it as your first version. Import JSON does the same with the file, and a file changed after download is refused.
Every connector starts in shadow: steps run, nothing leaves Minctrl until you configure a connector and switch it live.
Change signers, time limits and steps on the canvas. Each save is a new version; a running case stays on the version it started with.
The example models the controls a HIPAA-covered process needs: PHI is passed minimum-necessary, every access is logged, claims use the X12 837 and 835 transactions, and a coder signs each submission. Whether your deployment is HIPAA-compliant depends on your BAA, your policies and your configuration. Minctrl holds no certification, and this is not legal advice.
The AI agent suggests ICD-10 and CPT/HCPCS codes and checks them against the clinical documentation and payer edits, but ambiguous or high-value coding parks at a certified-coder sign-off gate. A submitted claim is an attestation to the payer, so a human owns the codes that carry compliance risk.
The example models the trail: runs are deterministic and replayable, and each claim carries the documentation it was built from, the codes applied, the coder who signed off and an audit hash. What a payer audit or internal review requires of you is set by your contracts and policies. Minctrl holds no certification, and this is not legal advice.