Healthcare AI Coordination Playbook
Coordination practices for AI agent teams managing healthcare organizations -- patient scheduling, HIPAA compliance, provider coordination, revenue cycle, referral management, and telehealth. Built for the unique regulatory, safety, and care continuity demands of medical practices.
Billing
Claim Denial Pattern Detection
The billing analytics agent tracks denial reasons by payer, provider, and procedure code. When denials from a specific payer spike (e.g., Aetna denying code 99213 at a 30% rate), it alerts the billing team with the pattern and the most common fix. Systematic denials are not random. They indicate a payer policy change, a coding error, or a missing modifier that affects every claim.
What goes wrong without this
Aetna changes their policy on modifier 25. Denials for evaluation and management services triple over 2 weeks. The billing team processes each denial individually. Nobody notices the pattern until month-end when revenue is down $40K. A pattern detection agent would have caught it on day 3.
Patient Balance Communication Coordination
The billing agent and the patient communication agent coordinate on outstanding balances. The billing agent determines the amount and aging. The communication agent determines the channel (portal message, text, letter) based on patient preferences and balance size. No collection communication goes out without both agents agreeing on timing, amount, and tone. Aggressive collection outreach on a patient who just had a difficult diagnosis is a reputation-destroying mistake.
What goes wrong without this
A patient receives a cancer diagnosis on Monday. On Tuesday, the automated billing system sends a collections notice for a $75 balance from 3 months ago. The timing is devastating. The patient posts the experience on social media. The practice's reputation takes a hit that costs far more than $75.
Prior Authorization Tracking with Expiry Alerts
The authorization agent maintains a registry of all active prior authorizations with their expiry dates and remaining approved visits. 14 days before expiry, it triggers a renewal request. When a patient books a visit requiring authorization, the scheduling agent checks the registry. No appointment is booked without confirming active authorization. Expired auth = denied claim.
What goes wrong without this
A patient's 10-visit PT authorization expired after visit 8. Visit 9 and 10 are rendered without authorization. Both claims are denied. The patient is billed $400. They are furious because "nobody told me." The practice either eats the cost or loses the patient.
Real-Time Eligibility Verification Before Every Visit
The eligibility agent verifies insurance coverage 48 hours before every scheduled appointment and again at check-in. If coverage has lapsed, it alerts the front desk agent and the patient before the visit, not after. A $200 visit rendered without valid insurance has a 40% collection rate. The same visit with verified insurance has a 95% collection rate.
What goes wrong without this
A patient's employer switched insurance carriers last month. The practice does not verify until after the visit. The claim is denied. The patient gets a surprise bill. They dispute it. The practice writes it off 90 days later. Multiply by 10 patients per week.
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