Clinical staff hours
Spent context-switching across ten different vendor portals instead of doing clinical work.
The Ai Workers. The healthcare-trained workforce behind every Solution.
An Ai Worker is a purpose-built agent that runs a specific healthcare workflow end-to-end. It reads the chart. It applies your rules. It assembles the evidence. It hands a recommendation to a human who makes the call.
The problem
The playbook you've been handed.
Healthcare organizations have been trained to scale administrative workflows the same way for decades. Hire when volume rises. Outsource when hiring lags. Buy a point solution when a workflow breaks. Each vendor brings its own audit trail, its own integration, and its own black box.
By the time it's all stood up, you don't have an AI strategy. You have a stack of vendors, a hiring pipeline that cannot keep up, and ten different recommendations on ten different screens that nobody can reconcile.
Here is where it breaks: the model assumes every workflow needs a different vendor. The workflows are different. The architecture they need is the same. Every healthcare administrative task reads a chart, applies a rule, assembles evidence, and routes to a clinician for the call. Buying ten vendors to do the same architecture ten times is how you end up with ten governance models and zero confidence.
01
Workflow breaks.
PA, claims, coding, appeals, OASIS, risk adjustment. One at a time.
02
Buy a point solution.
Each vendor solves one piece of the workflow and hands you another integration.
03
Reconcile the audit trail.
Ten vendors. Ten audit logs. Ten BAAs. One compliance team trying to make them line up.
04
Repeat.
Every new workflow. Every policy update. Every regulatory cycle.
It is not the vendor budget. It is what happens between the seams.
When every workflow runs on a different vendor with a different governance model, your clinical staff and your audit posture both pay the price. Recommendations that cannot be compared. Audit trails that cannot be reconciled. A clinician who has to learn a different interface for every queue.
The lightbulb
Different workflows. One architecture.
Every healthcare administrative workflow is built from the same primitives. Read the clinical context. Apply the rules. Assemble the evidence. Surface a recommendation. Hand it to a clinician. Learn from the outcome. The workflows differ in their rules, their evidence, and their endpoint. The architecture is identical.
The closed loop
- One healthcare-trained data and context layer feeds every Worker.
- Every Worker learns from outcomes and feeds the learning back across the workforce.
The result is a workforce that knows healthcare, knows your rules, and gets stronger with every recommendation your clinical staff confirms.
10 purpose-built Workers. Five Solution domains. One architecture.
Every Worker reads clinical context, applies your rules, assembles evidence, surfaces a recommendation, and routes to a human who makes the call. Glassbox by default. Composable across Solutions.
Utilization Management
Solution overviewPrior Authorization
PA requests ingested from any channel. Clinical documentation extracted, your plan-specific criteria applied, and recommendations surfaced to your reviewers with rationale and confidence scoring attached. Medical directors receive review-ready briefs with the evidence already mapped to the criteria.
Concurrent Review
Also known as Inpatient-Outpatient Review
Inpatient and outpatient stays monitored in real time. Length-of-stay criteria applied continuously. Discharge readiness, observation validation, and post-acute transitions surfaced with full context. Your reviewers engage on the cases that genuinely need them.
Retrospective Review
Post-service documentation reviewed, criteria matched, adjudication recommendations prepared with supporting evidence already organized. Every case arrives criteria-mapped and ready for clinical judgment.
Appeals & Grievances
First-level, second-level, and IRO coordination managed end-to-end. New evidence identified and analyzed against the original recommendation. Grievances logged, categorized, and routed. Medical directors receive cases with full context assembled.
Revenue Cycle Management
Solution overviewPresubmission Review
Claims evaluated across structural, clinical, coding, eligibility, authorization, policy, and denial-risk domains before they reach the payer. Findings routed to your reviewers with suggested corrections. Corrected claims return to your billing workflow after human approval.
Denials & Appeals Recovery
Denials classified by CARC/RARC, scored by financial impact and win probability, with clinical evidence retrieved and payer policy validated. Structured appeal packets assembled for your specialists to review and approve. Every recovered denial teaches Presubmission Review.
Risk Adjustment
Solution overviewProspective Risk Adjustment
Pre-visit and in-visit clinical notes read continuously. Supportable HCCs surfaced with chart evidence and ICD-10 codes attached. CDI queries route to the responsible clinician before the visit is signed. Coder confirms before submission.
Retrospective Risk Adjustment
Every chart in the population reviewed. MEAT evidence assembled. Recapture opportunities surfaced with chart excerpts and reasoning organized for the coder. Every confirmed code carries its evidence chain. RADV ready by default.
Coding
Solution overviewMedical Coding
Clinical documentation read at the encounter. CPT, ICD-10, and HCPCS codes surfaced with supporting evidence. NCCI edits, payer rules, medical necessity criteria, and modifier requirements applied before the coder sees the case. Coder reviews and submits with full context.
Home Health
Solution overviewOASIS Chart Review
Every OASIS assessment reviewed against the clinical documentation captured during the visit. M-items that conflict with the chart narrative flagged. Missing supporting evidence surfaced with a draft query for the visiting clinician already prepared. QA reviewer confirms or queries with the conflict in context.
One workforce. One architecture. Composable across every workflow.
Healthcare-trained from the floor up.
Every Worker is purpose-built for a healthcare workflow. Clinical vocabulary, regulatory rules, and payer policies are first-class inside the architecture.
Composable into Solutions.
Workers compose into pre-built Solutions for UM, RCM, Risk Adjustment, Coding, and Home Health. The same Worker can run inside multiple Solutions.
Your clinical staff makes the call.
Every Worker prepares the work. Your coders, reviewers, medical directors, and visiting clinicians review every recommendation and own every output.
One audit trail. One governance model.
Every Worker writes to the same audit trail, inherits the same governance, and produces Glassbox-traceable output. Your CISO, CDO, and compliance team see one model across the workforce.
The Glassbox. One model, every Worker.
The Glassbox
Every recommendation arrives with the clinical evidence, rules applied, reasoning path, and confidence scoring visible. No black box. The art of medicine stays with your clinical staff.
Full audit trail
Every recommendation, query, and reviewer action documented with clinical reasoning, evidence references, and data sources. Audit, RADV, and regulatory review ready at all times.
Configurable rules and criteria
Your plan-specific criteria, payer policies, coding guidelines, and internal standards applied consistently across every Worker.
Healthcare-native data layer
Every Worker reads from the same healthcare-trained data and context layer. Clinical vocabulary, master data, and entity resolution shared across the workforce.
Human in the loop
Ai Workers prepare the work. Your clinical staff applies their expertise and makes the call. Every Worker is built around the review checkpoint.
Continuous learning
Every confirmation, override, and outcome strengthens future recommendations across every Worker that touches the same workflow.
The next time a vendor tells you their AI is healthcare-specific, ask which workflow, which rules, and which audit trail. Then ask why you would buy ten different answers.
Healthcare administration runs on the same primitives across every workflow. Read the context. Apply the rules. Assemble the evidence. Surface a recommendation. Hand it to a clinician. One workforce should run them all.
Where the Workers compose.
Intelligent UM
Prior Authorization, Concurrent Review, Retrospective Review, and Appeals & Grievances composed into one closed loop.
Intelligent RCM
Presubmission Review and Denials & Appeals Recovery composed into one closed loop.
HCC Coding & Risk Adjustment
Prospective and Retrospective Risk Adjustment composed into one closed loop.
Medical Coding
The Medical Coding Worker deployed across the full provider coding workflow.
Home Health Coding
OASIS Chart Review composed with Medical Coding for the home health documentation cycle.
Snowflake Native Apps
The same Ai Workers, packaged as Snowflake Native Apps, running where your data already lives.