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Nashville's healthcare operations teams carry a disproportionate administrative burden. Prior authorization queues, payer communication backlogs, claims that bounce for preventable reasons, staff onboarding that takes three weeks because the materials are scattered across twelve systems. None of this requires clinical judgment. It requires process automation that actually works under HIPAA.
We build agents for the back-office work: gathering, formatting, routing, and tracking the information that flows between your team, payers, and systems. Every agent is designed with HIPAA-aware data handling and human review checkpoints for decisions that carry weight. We do not build clinical decision support tools.
Who this is not for: clinical decision support, diagnostic assistance, or any workflow where the agent would make treatment-related recommendations. We also do not build consumer-facing patient apps.
Healthcare ops automation has failed before because vendors treated HIPAA as a legal requirement to check off rather than an architecture constraint to design around. We start with data handling design, not features.
Every agent we build for healthcare starts with a data inventory: what PHI fields does this workflow touch, where does that data go, and how long does it persist in agent memory. We apply data minimization at the architecture level, not as a configuration option. BAA coverage for every cloud service is confirmed before the architecture is finalized.
Prior auth requests, claims submissions, and payer communications are multi-step processes that fail at specific hand-off points. We map the failure modes first, then build orchestrated agents using Temporal that handle retries, timeouts, and partial failures without losing track of where each case stands.
PA submissions and claims denials need a human sign-off before going out. We build configurable approval gates where the agent assembles the full package, presents it to the responsible team member with a structured summary, and waits for explicit approval. Override rates are logged and reviewable. Nothing goes out without a named approver.
Every workflow run produces a structured log: which records were accessed, what the agent did with them, who approved the output, and when it was submitted. Logs are retained per your policy and exportable for compliance review or internal audit. Your compliance team can review a complete record of any case the agent touched.
We have worked through the specific pain points that come up repeatedly in Nashville's healthcare operations landscape.
HCA and Vanderbilt Health system teams process large PA volumes. The agent gathers clinical criteria from the payer portal, matches them to the relevant documentation in your EHR integration, and produces a structured submission package for human review. The average assembly time drops from forty minutes to under five.
HealthStream clients managing staff onboarding across multiple facilities deal with manual assignment and tracking work that agents handle well. We build onboarding agents that read your facility's role requirements, assign the right training tracks, send reminders at the right intervals, and flag compliance gaps before they become audit findings.
Change Healthcare and revenue cycle teams deal with payer communication that involves retrieving denial reasons, drafting appeal letters, and tracking response timelines across dozens of payers. Agents can own the retrieval, drafting, and tracking while humans review every outbound communication.
Running in your environment, reviewed by your compliance team, tested against real workflow cases.
Data flow diagrams, PHI inventory, BAA list, and retention policy documentation for your compliance records.
Append-only logs with structured exports, pre-built to satisfy your compliance team's requirements.
Documented approval process, Slack or email integration for review prompts, and override rate dashboard.
Step-by-step for every failure mode, with escalation contacts and rollback instructions.
Direct access to the engineers who built it for thirty days, including compliance question support.
We treat PHI handling as a design constraint from day one, not a checkbox at the end. That means data minimization in every agent workflow (the agent only sees what it needs to complete the task), encryption at rest and in transit, audit logging for every record the agent touches, and BAA coverage for any cloud services used. We walk your compliance team through the architecture before we build.
Yes, and the distinction matters. The agents we build for PA workflows do the information-gathering and formatting work: pulling the relevant clinical criteria, matching them to the request, and preparing the structured submission package. A human reviews and approves every submission before it goes out. The agent handles the forty minutes of lookup and assembly; the clinician or ops specialist handles the judgment call.
Cost depends on payer complexity, the number of claim types, and whether the agent needs to integrate with your clearinghouse directly. We quote fixed scope after a two-day discovery session, so you know the number before you commit to anything.
Ten to sixteen weeks for a focused workflow. Discovery and architecture take two to three weeks because healthcare workflows have more edge cases than they appear to. Build and integration take six to eight weeks. Compliance review, UAT, and staged rollout take two to five weeks. We do not skip the staged rollout even when teams are eager to launch.
More questions? Send us a message or read the full service overview.