Provider & member support
Provider and member inquiries resolved and routed in your existing helpdesk - without replacing it, and without touching clinical decisions.
How the workflow runs
5 steps- 1
Ticket arrives
AutoProvider or member inquiry classified and tagged using your existing taxonomy
- 2
Enrich
AutoContext pulled from billing system, EHR, and payer portal into the ticket
- 3
Auto-resolve
AutoRoutine inquiries handled - eligibility status, claim status, remittance details
- 4
Route complex
AutoComplex billing issues routed to the right specialist with full context attached
+ 1 more steps
4
Automated
1
Human review
6
Systems connected
The problem
Today this work is mostly manual. People move data between systems, chase approvals, and re-check things that should already be correct.
- RCM staff reading and categorizing every provider inquiry - eligibility status, claim status, denial reasons
- Context scattered across the helpdesk, the billing system, and the EHR
- Escalations that lose context - the billing specialist starts from scratch
- Routine requests (eligibility checks, claim status, remittance inquiries) consuming RCM staff time
What we automate
The workflow handles the repetitive parts inside the systems you already use. No new tools to learn, no data to re-key.
- Classifying and tagging provider and member inquiries the moment they arrive - using your existing taxonomy
- Enriching tickets with context from the billing system, EHR, and payer portal
- Resolving routine inquiries automatically - eligibility status, claim status, remittance details
- Routing complex issues to the right billing specialist with full context attached
Before and after
- RCM staff reading and categorizing every provider inquiry - eligibility status, claim status, denial reasons
- Context scattered across the helpdesk, the billing system, and the EHR
- Escalations that lose context - the billing specialist starts from scratch
- Routine requests (eligibility checks, claim status, remittance inquiries) consuming RCM staff time
- RCM staff focus on complex billing issues, not repetitive status checks
- First responses arrive in minutes - providers get answers faster
- Escalations keep context - the billing specialist starts with the full history, not a blank ticket
- Consistent classification - no inquiries miscategorized because someone was rushed
Where humans stay in the loop
Automation handles the repetitive work. Your people handle the decisions that matter. The line is agreed and signed before launch.
- Escalations and complaints - a person handles anything sensitive or high-stakes
- Responses to novel issues the workflow has not seen before - routed to an RCM specialist
- Quality review of automated responses on a sample basis - keep the automation honest