Pedro Pires | Searcharxiv

arXiv2026

Agentic AI for Healthcare Claim Denial Analysis: A Policy-Grounded Framework for Privacy Preservation

In the healthcare sector, claim denials impose significant financial and administrative burdens, emphasizing the need for automated and trustworthy decision-support systems. This paper proposes a modular Agentic Artificial Intelligence (AI) framework for healthcare claim denial analysis, integrating specialized agents for denial risk prediction, risk factor identification, diagnosis-procedure-medication code relationship analysis, and counterfactual analysis. The framework integrates predictive analytics, graph-based learning, a Hybrid Contextual Retrieval-Augmented Generation (RAG) pipeline grounded in healthcare policy documents, and a dedicated HIPAA Compliance Agent to support privacy protection. Evaluated on a synthetic healthcare claims dataset, the framework achieved 98% traceability of reported numerical findings, validated 214 of 216 policy citations, and removed all 280 identified sensitive identifiers without modifying the underlying analysis. These findings pave the way for further research into Agentic AI as a framework for explainable, policy-aware, and privacy-preserving healthcare claim denial management.

cs.AI↗

arXiv2025

Control of Renewable Energy Communities using AI and Real-World Data

The electrification of transportation and the increased adoption of decentralized renewable energy generation have added complexity to managing Renewable Energy Communities (RECs). Integrating Electric Vehicle (EV) charging with building energy systems like heating, ventilation, air conditioning (HVAC), photovoltaic (PV) generation, and battery storage presents significant opportunities but also practical challenges. Reinforcement learning (RL), particularly MultiAgent Deep Deterministic Policy Gradient (MADDPG) algorithms, have shown promising results in simulation, outperforming heuristic control strategies. However, translating these successes into real-world deployments faces substantial challenges, including incomplete and noisy data, integration of heterogeneous subsystems, synchronization issues, unpredictable occupant behavior, and missing critical EV state-of-charge (SoC) information. This paper introduces a framework designed explicitly to handle these complexities and bridge the simulation to-reality gap. The framework incorporates EnergAIze, a MADDPG-based multi-agent control strategy, and specifically addresses challenges related to real-world data collection, system integration, and user behavior modeling. Preliminary results collected from a real-world operational REC with four residential buildings demonstrate the practical feasibility of our approach, achieving an average 9% reduction in daily peak demand and a 5% decrease in energy costs through optimized load scheduling and EV charging behaviors. These outcomes underscore the framework's effectiveness, advancing the practical deployment of intelligent energy management solutions in RECs.

eess.SY↗