Prior auths sit in a fax queue, referrals stall between specialties, and claims bounce back from the clearinghouse days later. We orchestrate those flows across the EHR, clearinghouse, and payer portals with HIPAA-aware, audit-logged execution — so revenue and patients both keep moving.
Healthcare operations lose money and goodwill in the gaps between systems. A prior authorization needs clinical detail from the EHR, a packet formatted to one payer's rules, a submission through the right portal, and follow-up until a decision lands. When a person carries that between screens and fax machines, authorizations expire, referrals leak to out-of-network, and denials pile up in a work queue nobody has time to clear.
We build event-driven orchestration across those touchpoints so each step fires when its trigger arrives and waits patiently for the systems it depends on. Protected health information stays inside your boundary, access is scoped to role, and every action against a patient record lands in an append-only log. The result is faster turnaround on authorizations and claims — and an evidence trail your compliance and revenue-integrity teams can actually stand behind.
Three capabilities, shaped by the EHR, the clearinghouse, and the rules each payer plays by.
Start where the manual handoffs cost the most in denied revenue, staff burnout, and delayed care:
It is built to be. PHI stays inside your boundary, access is least-privilege and role-scoped, and every step that touches a patient record is written to an append-only audit log. Deployments can run in your own HIPAA-eligible cloud or on-prem so protected health information never leaves an environment you control.
We orchestrate the prior-auth flow as event-driven steps that pull clinical detail from the EHR, assemble the payer-specific packet, submit through the right portal or X12 channel, and track status to approval or denial. Each payer's rules and timing live in configuration, and retries plus dead-letter handling keep a stalled submission from getting lost.
Pick the flow that bleeds the most — prior auth, denials, or referrals. In a thirty-minute briefing we map the systems it crosses and the orchestration that keeps it moving, and you leave with a scoped path and an ROI memo. Response inside 24 hours.