Forward-deployed in healthcare & life sciences
AI prepares the paperwork. Clinicians make the call.
We build AI into the administrative work around care: prior authorization, referral intake, coding and denials, patient messages, and regulated life-sciences documents. It runs inside Epic, Oracle Health, or Veeva, under a signed BAA, with every clinical decision left to clinicians.
Where the hours go
- Prior auth by hand
- Referrals that leak
- Denials worked in arrival order
- Regulated documents from scratch
What a pod builds
- Prior authorization packets
- Referral intake and scheduling
- Coding, denials, and appeals
- Payer contract analysis
What gets measured
- Prior authorization turnaround and first-pass approval rate
- Referral-to-appointment time
- Initial denial rate and clean claim rate
- Days in accounts receivable
What is different here
AI in healthcare works with protected health information, payer rules that differ plan by plan, and systems of record (the EHR, the clearinghouse, the validated quality system) that do not forgive a wrong write. The rules are moving, too: CMS-0057-F requires Medicare Advantage, Medicaid, CHIP, and federal-exchange plans to offer FHIR-based prior authorization APIs beginning in 2027. We build read-only first, cite every source, and leave each decision with a licensed or qualified person.
I / Where the hours go
What we look for first.
Prior auth by hand
Staff re-key the same clinical facts into a different portal or fax for every payer, then chase status by phone while the patient waits.
Referrals that leak
Referrals arrive by fax, e-fax, and portal, wait in a shared queue until someone reads them, and some patients book elsewhere before anyone calls.
Denials worked in arrival order
Denials are appealed one at a time as they arrive rather than by value or root cause, so the same eligibility or coding error returns next month.
Regulated documents from scratch
In life sciences, a medical information response, a deviation report, or an adverse event case must be complete, traceable, and on time, so experts spend their hours assembling instead of judging.
II / What we build
Systems, not slideware.
Prior authorization packets
Reads the order, the chart, and the payer’s current policy, assembles the documentation each criterion asks for, and hands the packet to a person: an authorization specialist to submit or, at a payer, a clinical reviewer to decide.
Referral intake and scheduling
Reads faxed and electronic referrals, extracts patient, insurance, diagnosis, and urgency into the EHR work queue, flags what is missing, and proposes a provider and slot across locations for a scheduler to confirm.
Coding, denials, and appeals
Suggests ICD-10-CM and CPT codes for a certified coder with the supporting text highlighted, groups denials by adjustment reason code and root cause, and drafts appeals citing the chart and payer policy for a biller to review.
Payer contract analysis
Extracts rates, carve-outs, timely-filing limits, and escalators from payer contracts, compares them with what each remittance paid, and gives the managed care team each underpayment with its clause attached, plus net revenue by payer and service line.
Patient messages and outreach
Sorts portal messages and contact-center requests by urgency and type, drafts replies, reminders, and prep instructions from the chart and your protocols, and holds anything clinical for a clinician’s review.
After the ambient scribe
Leaves the visit note to your ambient scribe and starts from what the clinician signed. It drafts documentation queries for your CDI specialists to review, and letters of medical necessity, citing the payer’s policy, for the clinician to sign.
Medical information and safety intake
Drafts answers to medical inquiries only from your approved standard responses, for a medical information specialist to approve, and flags possible adverse events and product complaints in the same inbox, opening prefilled cases for your safety team to assess.
Regulatory, quality, and trial documents
Drafts deviations, CAPAs, SOP revisions, submission sections, and monitoring visit reports from source records, QC-checks trial master file filings, and routes each through your validated Veeva or Medidata workflow for signature.
III / A first vintage
Prior authorization, one service line
First production deployment, Six to ten weeks
A pod connects the packet builder to your EHR work queues and payer portals for one high-volume service line, tests it on requests payers have already decided, and pairs it with your authorization specialists, who check every packet before submission.
Judged by
Order-to-submission time, first-pass approval rate, and specialist touches per request, each compared with the Survey’s baseline.
An illustration of a first deployment, not a description of a past client.
IV / What we measure
Baselined before we build.
- Prior authorization turnaround and first-pass approval rate
- Referral-to-appointment time
- Initial denial rate and clean claim rate
- Days in accounts receivable
- Underpayments found against contract terms
- Patient message response time
- Medical inquiry and safety case cycle time
Set during the Survey and reported every season after.
Systems we work inside
Your stack, not ours.
- Epic
- Oracle Health
- athenahealth
- eClinicalWorks
- NextGen Healthcare
- Waystar
- Availity
- Microsoft Dragon Copilot
- Salesforce Health Cloud
- HL7 FHIR APIs
- X12 278 and 835 transactions
- Veeva Vault
- Medidata Rave
- Oracle Argus Safety
Named for familiarity, not partnership. We integrate with what you already run and recommend new tools only when the work requires them.
V / Guardrails
Where people stay in control.
HIPAA and a signed BAA
We sign a business associate agreement before touching PHI, use the minimum necessary, de-identify wherever the task allows, and route PHI only to model endpoints covered by a BAA, never into training.
Credentialed people decide
AI assembles, drafts, and suggests; licensed clinicians and certified coders decide. No build denies, delays, or modifies care. That is the line California’s SB 1120 draws for health plans and insurers, and one we apply in every state.
Validated where records are regulated
Anything that touches a GxP record runs inside your validated system, with audit trails, electronic signatures, and change control under 21 CFR Part 11, and is tested with your quality unit before go-live.
Disclosure where the law asks
Patients get the AI disclosures state law requires: California’s AB 3030 covers AI-written clinical messages no licensed provider has reviewed, and Texas’s TRAIGA covers AI used in care. We add new statutes as they take effect.
Related
Work that tends to travel with this.
Operations & supply chain
Order exceptions, supplier follow-up, shipping paperwork, and S&OP: handled inside limits you write down.
Finance & FP&A
Forecasts, variance commentary, cash, and the board pack: sooner, with every number owned by finance.
Customer experience
Triage, agent assist, knowledge, and QA on every conversation, with a person always in reach.
Legal & compliance
Contract review, obligations, privacy requests, and audit evidence: faster, with counsel deciding.
Begin with the Survey.
Two to three weeks inside your operation, a fixed fee agreed up front, and a ranked plan you keep whether or not we build it together.