Scans patient charts before scheduled visits to surface suspected HCCs with MEAT evidence, generating physician-facing pre-visit briefs under CMS V28.
Retroactively mines closed charts for missed HCCs, prioritizes by financial impact, pre-validates against denial patterns, and batches for coder review and submission.
Analyzes incoming PA requests against NCD/LCD criteria, verifies provider credentials, and generates authorization decisions with full audit documentation under payer oversight.
Synthesizes each scheduled patient's chart into a one-page visit prep brief covering problem list, gaps, HCCs, meds, and items the physician should address today.
Ambient-listens to the patient–clinician conversation, drafts a structured SOAP note, surfaces HCC and care gap opportunities live, and routes to the physician for sign-off and EHR write-back.
Reconciles payer gap lists against clinical data, scans records for already-closed gaps, calculates HEDIS compliance, and prioritizes open gaps by clinical and financial impact.
Runs multi-channel patient outreach, triggers in-visit gap alerts, generates bulk standing orders with physician sign-off, tracks closure, and submits to payers.
Aggregates multi-source patient data, segments members into risk tiers, detects tier transitions, and generates care management worklists with explainable risk drivers.
Scores 30-day readmission risk at discharge, triggers tiered post-discharge outreach, monitors recovery signals, and escalates deteriorating patients to clinical teams.
Identifies social determinants from clinical notes and screenings, maps findings to Z-codes, matches needs to community resources, initiates referrals, and tracks outcomes.
Validates claim completeness, scores denial probability, flags high-risk claims with remediation recommendations, and submits clean claims to the clearinghouse.
Classifies denial root causes, assesses appeal merit with human oversight, generates appeal packages, tracks resolution, and feeds outcomes back to prevent future denials.
Ingests claims run-out, projects year-end shared savings or losses, identifies cost drivers, models interventions, and tracks ACO REACH risk corridor position.
Models new VBC contract opportunities with financial projections, sensitivity analysis, and risk assessments, producing executive decision packages—all recommendations require human approval.
Confirms upcoming appointments, handles reschedule requests conversationally, and finds the next compliant slot—routing every calendar change through a staff approval gate.
Identifies high-risk chronic disease patients, personalizes outreach campaigns, executes multi-touch voice/SMS sequences, and triages patient responses to close HEDIS/Stars gaps.
Helps members find the most affordable medication refills by comparing pharmacy pricing, calculating insurance cost-share, and generating interactive pricing guidance in the member's preferred language.
Detects referral orders, matches patients to optimal in-network specialists, checks prior auth, transmits referrals, tracks completion, and flags network leakage.
Replicates CMS attribution algorithms (MSSP, REACH, MA), predicts attribution changes, quantifies financial impact, and drives retention outreach to keep the right patients attributed.
Walks providers through a structured sertraline safety assessment—Black Box monitoring for paediatric patients, serotonin syndrome screening, drug interaction checks, GAD-7 disease control, and PharmD escalation on hard stops.
Walks providers through a structured warfarin assessment—bleeding versus thromboembolic risk balance, INR therapeutic-range adherence, drug-food interaction screening, dose-adjustment guidance, and PharmD escalation on hard stops.
Walks providers through a structured GLP-1 receptor agonist assessment—MTC and MEN2 contraindication screening, GI tolerability and titration pacing, pancreatitis surveillance, glycaemic and weight trajectory monitoring, with PharmD escalation on hard stops.
Enforces Clozapine REMS programme compliance—mandatory ANC monitoring gates, agranulocytosis and myocarditis screening, metabolic and seizure threshold surveillance, bowel obstruction prevention, with PharmD escalation on hard stops.