One to fifty providers, a front desk on the phone all day and insurance checks done by hand.
Dental, physical therapy, behavioural health, dermatology and med spa — you pay someone to sit on hold with payers.
Eligibility, prior authorization and denials are the slowest part of getting paid.
Several locations, the same EHR, and the same manual steps repeated at every front desk.
Numbers from the AMA, CAQH and MGMA — the hours go into payer paperwork and phone calls, not into patients.
a week of physician and staff time goes into prior authorization — about 43 requests per physician every week.
of physicians employ staff who work exclusively on prior authorizations.
of physicians report care delays caused by prior authorization; 78% say patients sometimes abandon treatment because of it.
of practices name eligibility and prior-authorization calls as their most time-consuming phone task; scheduling is next at 31%.
and about $14 is what one eligibility check costs at specialty and behavioural-health practices — three times longer than in primary care.
a year of staff time goes into routine provider–payer transactions, and 97% of that cost sits with providers.
Put your monthly volume into the calculator and see hours and dollars.
The run path of a typical practice workflow. Every booked visit travels it on its own; anything clinical or uncertain stops and goes to a person.
A booking in athenahealth, eClinicalWorks, Dentrix or your PM system starts a run; online intake forms land in the same place.
Schedule & verifyReads demographics and insurance from the EHR or the intake form; an insurance-card photo is read by OCR.
Schedule & verifySends an electronic eligibility request through Availity, Waystar or your clearinghouse and writes copay, deductible and plan status back to the chart.
Schedule & verifyInactive plan, out-of-network or missing data goes to the front-desk queue with the reason; clean checks continue silently.
Schedule & verifyPayer rules by procedure code and plan decide whether the visit or procedure needs prior authorization.
Authorize & intakeA language model pulls the relevant notes, orders and results from the EHR through FHIR into the payer’s required format for a clinician to confirm.
Authorize & intakeSubmits via ePA or the portal, polls the status daily and alerts the coordinator when it is approved, denied or stalls past the payer’s turnaround.
Authorize & intakeFaxes and PDFs from eFax or RingCentral are classified — referral, records, lab — and matched to the patient; low confidence goes to a nurse.
Authorize & intakeAttaches the classified document to the right patient and notifies the care team.
Authorize & intakeSMS or email through Twilio or Weave three days and one day before; replies of “confirm” or “reschedule” update the schedule.
Remind & reportCancelled slots are offered to the waitlist in order, and the first patient to accept takes it.
Remind & reportReads the 835 remittance, maps the denial code to a cause and drafts the appeal for the billing specialist to review.
Remind & reportMorning summary in Slack or Teams: eligibility failures, authorizations pending, no-shows and faxes waiting for review.
Remind & reportWorkflow automation in healthcare takes the administrative path around every visit — enter the patient, verify insurance, decide whether a prior authorization is needed, gather the records, submit, chase the status, remind the patient, sort the incoming faxes — and lets a workflow do the routine steps on its own. In a typical practice the front desk and the billing team spend most of their day not on patients but on payer portals, hold music and retyping. That is the part automation in healthcare removes, while every clinical decision stays with the clinician.
We build it around the systems you already run rather than a new platform. A booking in athenahealth, eClinicalWorks, Dentrix or your PM system starts an electronic eligibility check through Availity, Waystar or your clearinghouse, and the result is written back to the chart. Payer rules decide whether the procedure needs authorization; a language model assembles the packet from the EHR for a clinician to confirm, and the flow submits it and tracks the answer. Incoming faxes are classified, matched to the patient and filed. Reminders go out by SMS and email, replies update the schedule, and the billing specialist receives a drafted appeal for every denial.
Eligibility is known before the patient arrives, authorizations stop waiting in someone’s to-do list, faxes reach the chart the same day and no-shows fall because reminders actually go out. Wireclad builds these workflows with self-hosted n8n, EHR and clearinghouse APIs and language models under a Business Associate Agreement — where a system has no API, robotic process automation in healthcare settings is used only as a last resort, step by step.
Typical front-desk minutes per visit in a small practice. Your own numbers go into the calculator below.
Based on 25 min by hand and 3 min with the flow per item, from the table above.
The flow verifies, assembles, files and reminds. Clinicians and staff keep every decision about care, submissions and patients.
Medical necessity and treatment are decided by the clinician — the flow only gathers paperwork.
A clinician or coordinator confirms every submission; peer-to-peer calls stay with the physician.
When the model is unsure which patient or document type, a nurse checks before it enters the chart.
Upset or complex calls are handed to a person immediately, not kept in a bot.
The flow drafts; a billing specialist decides what is sent.
Who can see what, and what happens when something goes wrong, is decided by you under your HIPAA policies.
Flip a switch to hand a step to the flow or take it back.
Benchmarks from the AMA 2024 Prior Authorization Physician Survey, the CAQH Index and MGMA Stat polls: the time is in eligibility, authorizations and phones — exactly where a workflow takes over the routine part.
We map the process as it runs today, count the minutes and agree what the flow must never do on its own.
A working flow on your real data, in a sandbox. You see every run and every exception.
Edge cases, approvals and alerts, then the switch-over — with the old way kept as a fallback.
Monitoring, fixes when a vendor changes a format, and a monthly report of hours saved.
Yes. We sign a Business Associate Agreement, run n8n self-hosted in your own environment, and use only language-model and messaging providers that sign a BAA themselves. Nothing is routed through consumer AI tools.
Most modern EHRs expose FHIR or vendor APIs, and clearinghouses such as Availity and Waystar handle eligibility and claims. Where an API is closed or paid, we start with what is open — scheduling, intake, faxes, reminders — and discuss the rest honestly before the project starts.
No, and it should not be. The flow decides whether an authorization is needed, assembles the packet from the chart, submits it and tracks the status. A clinician confirms the packet, and peer-to-peer reviews stay with the physician.
In your systems — the EHR, your clearinghouse and your own server or cloud account. The workflow holds only what it needs for a run, access is role-based and every step is logged for your audit.
It depends on your payer mix and volume — put your own numbers into the calculator above. Eligibility checks drop from many minutes to seconds; packet assembly and fax sorting shrink to a quick review. The phone still rings, but about the harder things.
Every model step has a confidence threshold and a human queue. A fax it cannot match, a packet that is incomplete or a reply it does not understand goes to a person with the context attached — it never writes to the chart on a guess.
Where a payer portal has no API we do use browser automation as a last resort, but most of the work runs through proper APIs, which are more reliable and leave an audit trail. We choose the method per step, not one tool for everything.
Describe it in two sentences — we reply within a day with a workflow sketch.
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