AI Solutions for Healthcare
HIPAA-compliant AI agents and automation for medical billing companies
Sound familiar?
Billers lose hours to payer portals
Checking eligibility, pulling claim status and copying results into the practice management system is the same clicking, every day, for every claim. Skilled billers do clerical work while denials wait.
Denials sit unworked past the deadline
Denied claims pile up faster than anyone can categorize them. Timely filing windows close, appeals never get drafted, and revenue that was earned is quietly written off at month end.
Onboarding and tasks live in chat threads
New hires get access by email request, training by word of mouth, and daily work through WhatsApp messages. Nobody can see who owns what, which accounts are late, or how productive each biller is.
What you get
- RCM process and PHI data map
- HIPAA-aligned agent architecture
- Eligibility and claim status agents
- Denial triage with appeal drafts
- AR worklist prioritization
- HR onboarding automation
- Daily task and SLA automation
- Client KPI reporting agent
- Audit logs and compliance docs
Stack and tools
- Claude API under BAA
- Azure OpenAI
- AWS Bedrock
- Self-hosted models via Docker
- n8n (self-hosted)
- Model Context Protocol
- PostgreSQL with encryption
- Clearinghouse APIs
- Practice management integrations
- Cloudflare Access
- Audit logging
How we do it
- 1
Map the revenue cycle
We sit with your billers and map every step from eligibility to payment posting, mark where PHI flows, and pick the two or three workflows where automation returns the most hours first.
- 2
Design for PHI
Every agent gets a least-privilege tool set, PHI is minimized or de-identified before any model call, and the provider sits under a BAA or runs inside your own environment.
- 3
Build with approval gates
Agents draft, prioritize and prepare. A biller approves anything that touches a claim, a patient or a payment. Historical cases are replayed through the flow before it sees live data.
- 4
Automate the operation
n8n handles onboarding, access provisioning, daily worklists, SLA alerts and weekly productivity reports, so managers see the whole operation without chasing updates in chat.
- 5
Run, audit, expand
We go live on one client account, review audit logs and accuracy weekly, deliver the compliance documentation your clients ask for, then extend the agents to the next workflow.
The agent and automation catalog
Eligibility and benefits verification agent
Checks coverage, copays, deductibles and authorization requirements before the visit, through payer APIs or portals, and writes the result back to your practice management system.
Claim status and follow-up agent
Pulls claim status from clearinghouses and payer portals on a schedule, flags claims stuck past your threshold, and prepares the follow-up note or call sheet for the biller.
Denial triage agent
Reads CARC and RARC codes, classifies the root cause, checks timely filing limits, and drafts the appeal or corrected claim for a biller to approve before anything is sent.
AR worklist prioritizer
Ranks open accounts by age, balance, payer behavior and filing deadlines so each biller starts the day on the accounts most likely to pay and most at risk of being lost.
Patient statement and payment-reminder agent
Sends statements and reminders by the channel each patient consented to, answers balance questions from approved content, and routes disputes to a person with the full history.
Coding and documentation assistant
Suggests CPT and ICD-10 codes from encounter documentation with the supporting text highlighted, for a certified coder or biller to confirm, reject or edit before submission.
HR and onboarding automation
n8n workflows generate offer letters, collect documents, provision system access, assign training checklists, track completion, and revoke access on the day someone leaves.
Task management automation
Builds daily biller worklists from practice management and clearinghouse data, raises SLA alerts in Slack or WhatsApp when accounts go stale, and compiles weekly productivity reports.
Client reporting agent
Compiles days in AR, clean-claim rate, denial rate and collections per client each month, writes the commentary for a manager to review, and delivers the report on schedule.
How we keep PHI safe
- Business Associate Agreement with the model provider (Anthropic, OpenAI, Azure OpenAI or AWS Bedrock), or a self-hosted model inside your VPC via Docker when no BAA is acceptable
- PHI minimization and de-identification before inference, so the model only sees what the task needs
- Zero data retention with the provider and no training on client data
- Encryption in transit (TLS 1.2 or newer) and at rest (AES-256)
- Role-based access control and multi-factor authentication for every user and service account
- Least-privilege MCP tools scoped per agent, read-only wherever the task allows
- Immutable audit logs of every agent action and every PHI access
- Human-in-the-loop approval for anything that touches a claim decision, a patient or money
- Risk assessment, incident response plan and breach-notification procedure delivered with the system
- Workforce training material for your billers and managers
Starting at
from $7,500
Typical timeline 4 weeks. First release covers two agents plus HR and task automation for one client account.
Related work
Healthcare AI & RCM Automation: questions people ask
Further reading
Let's scope your healthcare ai & rcm automation project.
Tell us what you are building or what is slowing you down. We reply within one business day.