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Appeal Intake &
Classification Agent

Turn unstructured appeal volume into clean, case-ready data automatically.

Appeals don’t slow down because your teams aren’t working hard. They slow down because intake is manual, document-heavy, and inconsistent.

 

Quisitive’s agent-driven intake layer captures inbound appeals, extracts key data, classifies them accurately, and creates structured cases in Dynamics 365 - fast.

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Appeal intake sets the pace and risk

for everything downstream.

When appeal intake is manual, teams spend their time sorting, re-keying, and chasing missing information instead of moving cases forward. Classification varies by reviewer. Case creation gets delayed. And deadlines become harder to defend.

The scale is real:

Claims denials are common:

Insurers of HealthCare.gov marketplace plans denied 19% of in-network claims in 2024 (about 1 in 5), sustaining high downstream denial and appeal activity. (kff.org)

Bad data is a top driver:

Experian’s 2025 State of Claims findings highlight missing or inaccurate data as the leading cause of denials (the #1 reason reported). [experian.com]

The bottom line is that if intake is inconsistent, everything after it becomes slower, more expensive, and harder to audit.

What our Appeal Intake & Classification Agent Delivers

AI + Dynamics 365 + your existing intake channels

Solve what slows appeal intake today:

Manual document review

Incomplete submissions

Inconsistent classification across teams

Delayed case creation and routing

Limited visibility into intake performance

Replace manual effort with intelligent workflows

Centralized multi-channel ingestion (email, uploads, PDFs)

AI extraction and normalization from unstructured documents

AI-based classification (true appeal vs. non-appeal + type) with confidence scoring and exception handling

Automated case creation in Dynamics 365 Customer Service with documents linked via Dataverse and SharePoint

Intake performance dashboard (volume, accuracy, exceptions)

How our Appeal Intake & Classification Agent Works
Ingest & Centralize

Capture inbound appeal documentation and centralize it for structured processing.

Extract & Normalize

Use Azure AI Document Intelligence to extract fields and convert unstructured documents into machine-readable data.

Classify with Confidence

Identify true appeals and categorize by type (clinical, administrative, coding, etc.), with confidence thresholds and exception routing.

Create Case Records Automatically

Generate structured cases in Dynamics 365 and link supporting documentation through Dataverse.

Monitor & Improve

Track volume, accuracy, and exceptions, then tune models over time.

Why Healthcare Leaders Choose Quisitive
Microsoft Solutions Partner for Business Applications and Data & AI
Early adoption of Copilot Studio and agent-based architectures
Proven methodology combining AI, agents and Dynamics 365
Pre-built accelerators for document intake and classification
End-to-end delivery—from intake foundation to autonomous operations

FAQ

By converting inbound documents into validated, structured data and creating Dynamics 365 cases automatically, so downstream teams start with clean cases instead of fixing intake errors.