Proof of concept · Healthcare
Four agents scan insurance cards, verify coverage, resolve exceptions and flag prior authorizations, with staff working in Workato GO or Teams.
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Manual, reactive checks fail on a wrong ID, a payer API outage or a missing authorization, and one mistake can delay care.
An agentic eligibility framework built on Workato GO, Microsoft Azure and Epic.
Scans insurance cards, validates patient data and flags discrepancies before they delay care.
Verifies coverage, resolves transient errors and standardizes payer responses.
When something fails, it investigates, finds the fix and notifies staff with clear next steps.
Identifies procedures that need approval and pre-fills the request before a claim is denied.
Staff search, act and resolve from Workato GO or Microsoft Teams.
Overview
Eligibility checks are manual, reactive and prone to error, and legacy systems cannot handle the complexity. A wrong member ID, a payer API outage or a missing authorization can delay care or cost thousands.
Four agents share the work. The intake genie scans insurance cards, validates patient data and flags discrepancies. The eligibility genie verifies coverage, resolves transient errors and standardizes responses. The exception genie investigates failures and gives staff a clear fix, and the prior auth genie finds procedures that need approval and pre-fills the request. Staff search, act and resolve from one interface: Workato GO or Microsoft Teams.
Outcomes
Integration
Platforms
Where this applies
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