Combining the precision of artificial intelligence with the empathy and judgment of human professionals
Combining the precision of artificial intelligence with the empathy and judgment of human professionals
Our role-based AI agents do the work of a fully-staffed healthcare backoffice, looping in human experts when needed to advise on edge cases and exceptions.
Proprietary AI Agents are coded to your business rules, completing routine tasks like processing new patient referrals in minutes. Once deployed, AI Agents run 24 hours a day 365 days a year.
+Humans work in tandem with AI Agents to handle edge cases and exceptions. Our +Human agents are based in the Philippines, providing all the cost and talent benefits of offshore staffing.
Dramatically increase capacity without increasing headcount, transforming every department of your organization without needing to rip-and-replace existing software systems.
Automate up to 80% of complex, multi-step processes. Agentic AI agents learn and adapt through ongoing interaction with +Human experts.
AI agents: gather referral data, capture and transcribe documents, set up patient accounts in EHR, and send basic scripted texts and emails.
+Humans: crosscheck daily referrals from EHR vs patient accounts created, review prescription information before care is delivered, and handle exceptions such as no response from doctor’s office (calls office) or patient (calls patient).
AI agents: run automated payer portal checks, extract benefit details, auto-populate EHR and billing software, run pre-checks before appointments, and basic scripted texts and emails
+Humans: handle exceptions, direct payer phone calls, relationship-based interactions and advocating for
the patient when necessary, final decision-making, and compliance sign-off.
AI agents: review scheduled orders, match to payer rules and flag which ICD-10 and HCPCS codes require prior authorization, auto-populate forms, submit directly via API, and early detection of potential documentation issues before denials occur.
+Humans: handle exceptions, direct payer phone calls, urgent or escalated appeals, interpret grey areas or otherwise complex or conflicting guidelines.
AI agents: review and summarize patient notes in required clinical format, suggest and apply ICD-10 and HCPCS codes, verify documentation contains all mandatory fields for billing and compliance.
+Humans: handle exceptions, complex coding decisions, ambiguous cases, direct provider queries, and regulatory oversight.
AI agents: auto-validate orders before billing, automate invoice generation and submission, cross-system data integration.
+Humans: coordination with other departments for readiness before billing.
AI agents: audit ERA/835 files and EOBs to detect denied claims, group by denial code, and assign reason categories; root cause analysis; draft and send initial appeals letters; sort and attach evidence to appeals; and report on deadlines.
+Humans: oversee complex and high dollar appeals, handle human-to-human multi-issue communication, and address systematic issues with other departments.
AI agents: where a patient pay balance is owed, create and send invoices automatically, track due dates, and send reminders.
+Humans: answer patient questions about billing that require a soft touch and empathy, negotiate payment plans, and address disputes.
AI agents: ingest digital and paper ERA files and post payments to patient accounts, detect denials and route to denial management, reconcile payment postings with bank deposits, report on trends like slow payment cycles or chronic underpayment and flag to +Humans.
+Humans: oversee and contact payers about discrepancies and disputes.
In this video an AI+Human team process a new patient referral by fax. A team of 2-3 AI Agents and one +Human agent dramatically decreases the amount of human time spent per referral, from 15 minutes down to ~1 minute.
AI Agents train at a similar speed to human employees. New agents are planned and delivered, by role, in sprints.
Qualify scope and work priorities
Establish controls, confirm resources
Deliver cyclic work packages as sprints
Increase load, stabilize new way of working
Continuous improvement
Qualify scope and work priorities
Establish controls, confirm resources
Deliver cyclic work packages as sprints
Increase load, stabilize new way of working
Continuous improvement
Train and deploy one or more AI+Human teams in tandem or sequentially.
AI Agents train at a similar speed to human employees. New agents are planned and delivered, by role, in sprints.
Qualify scope and work priorities
Establish controls, confirm resources
Deliver cyclic work packages as sprints
Increase load, stabilize new way of working
Continuous improvement
Qualify scope and work priorities
Establish controls, confirm resources
Deliver cyclic work packages as sprints
Increase load, stabilize new way of working
Continuous improvement
Train and deploy one or more AI+Human teams in tandem or sequentially.
Healthscope-Agility is proud to announce Spectar Health Inc. a joint venture with Spectar Group, a global innovator in AI and hyper-automation technologies. Spectar Group has been a pioneer in digital worker technology since 2019, receiving global recognition by Gartner as a preferred partner for offering hyper automation implementation and managed services.
Healthscope-Agility is proud to announce Spectar Health Inc. a joint venture with Spectar Group, a global innovator in AI and hyper-automation technologies. Spectar Group has been a pioneer in digital worker technology since 2019, receiving global recognition by Gartner as a preferred partner for offering hyper automation implementation and managed services.
