ASC for Healthcare

Staff spent an average of 20 minutes per prior authorization, manually pulling chart evidence and matching it to each payer's policy, and the backlog was pushing some procedures out by two weeks.

ASC built a prior authorization agent that reads the encounter and clinical notes in Epic over FHIR, checks the payer's medical-policy criteria, assembles the documentation, verifies benefits, and submits through the payer portal, routing only true exceptions to a nurse reviewer for sign-off.

The agent now automates up to 90 percent of prior authorization requests and reaches roughly 85 percent real-time approval, with submissions filed clean on the first pass.

Roughly one in seven claims came back denied, and the billing team could only work a fraction of the queue, leaving recoverable revenue to age out past appeal deadlines.

ASC built a denial appeals agent that reads the 835 remittance and denial codes, identifies the root-cause pattern, pulls the corrective clinical and billing evidence from the EHR and X12 claim record, then drafts and files the appeal end to end, with a coder signing off on clinical-judgment cases.

Denials fell around 30 percent and net revenue rose near 20 percent within two quarters of putting the agent on the queue.

Clinicians were spending two to three hours a day writing notes after visits, and chart-closure delays were holding up coding and billing across the network of roughly 200 providers.

ASC built an ambient documentation agent that listens to the visit, generates the structured note and suggested ICD-10 codes, and files a draft into the EHR for the clinician to review and sign, with no manual typing and full PHI handling under HIPAA.

Clinicians reclaimed 2 to 3 hours a day from documentation and administrative burden dropped near 30 percent, with notes closing the same day instead of days later.