1:36Healthcare
Agentic Healthcare Eligibility Framework
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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- Epic
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Proof of concept · Healthcare
Healthcare OPS Genie: Referral to Registration
Turns a referral email into a registered patient in Salesforce Health Cloud, collects ID and insurance documents and checks eligibility with Waystar.
Video and presentation
In the video
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The cost of manual operations
Healthcare staff lose much of their time to repetitive data entry across disconnected systems.
Today's referral process
Staff extract data from the referral, enter it into Epic and Salesforce Health Cloud, check eligibility in Availity and pVerify, then schedule and notify the care team by hand.
Meet Healthcare OPS Genie
An AI assistant built on Workato that handles registration, eligibility verification and operational coordination.
Referral email to registered patient
The first recipe extracts demographics and clinical notes with OCR and registers the patient in Salesforce Health Cloud with an MRN.
Welcome and document request
The patient receives a welcome email with next steps, then a request for their driving licence and insurance card.
Documents verified
A recipe checks both documents and confirms by email that each one was processed.
Eligibility through Waystar
A direct API connection to Waystar validates the insurance card. When data is missing, the response lists the fields to correct.
Chat for admin staff
In Workato GO, staff look up a patient by MRN, log a complaint and research insurance status in Azure Health Data Services.
Overview
The problem, and what the POC does.
The problem
When a referral arrives, registration staff copy patient details from the attachment into Epic and again into Salesforce Health Cloud, check eligibility in Availity and then pVerify if that fails, and finally schedule the visit and notify the care team. Each patient takes hours of manual work.
What the POC does
OPS Genie runs on Workato recipes. A referral email triggers the first recipe, which extracts demographics and clinical notes with OCR and registers the patient in Salesforce Health Cloud with an MRN. The genie sends a welcome email, asks the patient for a driving licence and insurance card, validates both and checks eligibility directly through Waystar, telling the patient which fields to correct when data is missing. Admin staff then work with the genie in a Workato GO chat.
Outcomes
What it is built to improve.
- Patients registered from the referral email without re-keying
- ID and insurance card collected and validated by email
- Eligibility checked through Waystar, with missing fields sent back for correction
- Admin staff look up patients, log complaints and check coverage in one chat
Technologies used
Where this applies
Related agent and use cases.
Discuss This Workflow
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