AI Automation meets human expertise
Combining the precision of artificial intelligence with the empathy and judgment of human professionals
AI Automation meets human expertise
Combining the precision of artificial intelligence with the empathy and judgment of human professionals
Our model
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.
Specia™ AI Agents
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.
+Human Agents
+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.
Results
Dramatically increase capacity without increasing headcount, transforming every department of your organization without needing to rip-and-replace existing software systems.
Role-based AI Agents
Automate up to 80% of complex, multi-step processes. Agentic AI agents learn and adapt through ongoing interaction with +Human experts.
Patient Intake
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).
Eligibility Verifications
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.
Prior Authorizations
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.
Treatment Documentation
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.
Sales Orders and Billing
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.
Denials Management
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.
Patient Collections
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.
Payment Posting
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.
Watch Demo
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 run at the maximum speed of existing systems
- AI Agents work 24/365, don’t get sick, don’t take time off
- Data is processed with 100% accuracy, not subject to human error
- Human time per referral is decreased from 15min to ~1min
- AI Agent+Human team can process up to 480 referrals in an 8 hour shift, up from 32 referrals by one human alone
AI Agents can be coded to work with almost any existing software stack.
Onboard in 4-6 weeks
AI Agents train at a similar speed to human employees. New agents are planned and delivered, by role, in sprints.
Qualify
Qualify scope and work priorities
Plan
Establish controls, confirm resources
Deliver
Deliver cyclic work packages as sprints
Transition
Increase load, stabilize new way of working
Support
Continuous improvement
Qualify
Qualify scope and work priorities
Plan
Establish controls, confirm resources
Deliver
Deliver cyclic work packages as sprints
Transition
Increase load, stabilize new way of working
Support
Continuous improvement
Train and deploy one or more AI+Human teams in tandem or sequentially.
Patient Intake
Eligibility Verification
Prior Authorizations
Treatment Docs
Sales Orders & Billing
Denials Management
Patient Collections
Payment Posting
Brought to you by:
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.