Transform Healthcare Workflows
with Human-in-the-Loop AI Solutions
Your PA coordinators are on hold with Aetna. Your coders are three days behind on discharges. Your front desk is manually checking eligibility on Availity while patients stack up in the waiting room. Denial rates are climbing past 12% and half those claims never get appealed. We build human-in-the-loop AI that plugs directly into EHRs like Epic, Cerner, or Athena — handling the work your team shouldn't be doing manually, with strict data privacy controls and every action logged.
* We scope and propose the solution at no cost. No hidden fees, no commitment until you see the plan.
Where the Hours Actually Go
Every rev cycle leader knows where the bottlenecks are. Prior auth, denials, coding, scheduling, eligibility — these are the workflows eating your FTEs alive. Here is exactly how we tackle each one, with your staff still in the loop on every decision that matters.
Prior Authorization Processing
Your PA coordinators are spending 35 minutes per request — calling Aetna, sitting on hold, faxing clinical notes to UHC, logging into four different payer portals. Meanwhile the patient is waiting for their MRI approval and the surgeon's schedule is slipping. We pull the clinical evidence straight from your EHR, auto-fill the payer-specific form (whether it's Availity, the BCBS portal, or Change Healthcare), and submit electronically. That 35 minutes drops to 7. Across a 50-physician group averaging 39 PAs per doc per week, that's $1.3M/year back in your pocket.
Claims Denial Management
You know the numbers: denial rates have crept past 12%, and your team only has bandwidth to appeal maybe a third of them. The rest — CO-197s, CO-4s, missing auth denials — just age out. That's pure revenue walking out the door. We read every ERA/EOB as it comes in, categorize the denial by CARC/RARC code, pull the original clinical documentation from the chart, draft a payer-specific appeal letter with the supporting evidence attached, and resubmit within the timely filing window. A 300-bed hospital running this is recovering $1.2M+/month in revenue they used to write off.
AI Call Center for Scheduling
Your call center is fielding 2,000+ calls a day but you're only staffed to answer 60% of them. That means 140 abandoned calls daily — patients who needed a follow-up, a reschedule, or a new patient appointment. At your average reimbursement, that's roughly $45K/month in lost revenue from appointments that never got booked. Our AI voice agent handles scheduling, rescheduling, cancellations, and basic insurance questions directly in your PM system. It sends 48-hour and 2-hour SMS reminders, and it never puts anyone on hold. No-show rates drop from 23% to 11%. Net savings: ~$843K/year.
AI-Assisted Medical Coding
Good luck hiring certified coders right now — there's a national shortage and your DNFB is growing every week. Meanwhile, coding error rates run 7-25% industry-wide, and a 1% inaccuracy on $200M in billings is $2M in lost revenue before you even count the denials it triggers. Our AI reads the discharge summary and op notes, suggests ICD-10 and CPT codes with confidence scores, flags anything below threshold for your coders to review, and catches CDI opportunities your team might miss. Charts that took 4 minutes now take 48 seconds at 97.8% accuracy. Your coders focus on the complex cases — the ones that actually need a human.
Insurance Eligibility Verification
Your front desk staff are spending 12+ minutes per patient logging into Availity or the payer's own portal, copying member IDs, verifying coverage is active, and checking if the plan even covers the visit type. When they miss something — or the patient switched jobs and didn't mention it — you get a CO-27 denial weeks later. We run a real-time 270/271 eligibility transaction before the patient even sits down, flag any coverage gaps or secondary payers like Medicare Part B, and present the copay, deductible remaining, and coordination of benefits to the front desk in 42 seconds. That's $807K/year in prevented denials and rework.
Your Compliance Team Will Actually Like This Part
BAA in place, PHI handled per the Privacy and Security Rules. Your compliance officer gets full documentation before go-live.
Independently audited security controls covering availability, confidentiality, and processing integrity.
Aligned to the industry security frameworks so your risk assessment doesn't become a six-month project.
AES-256 at rest, TLS 1.3 in transit. No PHI stored in plaintext, period. Your IT security team can verify the architecture end to end.
Role-based access with minimum necessary enforced at every layer. Your admins control who sees what — we never override that.
Every PHI access, every AI decision, every human override — logged with timestamp, user ID, and reason. Exactly what OCR and your internal auditors want to see.
How We Work
We don't sell you a platform and wish you luck. We come on-site, learn your workflows, build to your spec, and stay until it's working.
Discovery & On-Site Assessment
We shadow your PA coordinators, sit with your coders, watch your front desk run eligibility checks. We map every step — where the bottlenecks are, which payer portals your team is logging into, what your days in AR look like by payer. The assessment and proposal are free.
Approval & Development
Once you sign off on the scope, we build. That means configuring to your specific EHR (Epic, Cerner, Athena), your clearinghouse, your payer mix, and your internal workflows — not a generic template that your team has to work around.
Integration & Testing
We integrate via HL7/FHIR APIs into your existing stack — no rip-and-replace. Then we run it against real claims data in a test environment, validate accuracy against your coders, and get sign-off from your compliance and IT security teams before anything touches production.
Go Live & Continuous Improvement
We go live, monitor every transaction, and tune. You get dashboards showing clean claim rate, days in AR by payer, denial rates by CARC code, and PA turnaround times. The system gets sharper with every claim it processes — and we stay engaged to make sure it does.
Stop Losing Revenue to Manual Workflows
Your team is burning hours on work that should take seconds — chasing auths, reworking denials, manually verifying eligibility. Let us show you exactly how much revenue you're leaving on the table and what the fix looks like.