Industry playbook
Healthcare administration
Referrals, intake and prior authorisation are paperwork systems wearing clinical clothes.
For: Clinic operators, care-coordination teams and health-tech founders working under HIPAA or equivalent.
- EHR
- Fax and e-fax
- Payer portals
- Scheduling tools
Documented vs real
This illustrative documented process has 4 steps. The illustrative alternative has 7.
A starting hypothesis from this kind of work. Every audit re-maps it with your team.
What the document says
- 1.Referral received
- 2.Patient scheduled
- 3.Visit
- 4.Billed
Illustrative exception path
- 1.Referral arrives by fax with missing fields
- 2.Staff call the referring office
- 3.Insurance checked on a separate portal
- 4.Prior authorisation filed and chased
- 5.Patient contacted several times to schedule
- 6.Records requested from another provider
- 7.Billing rejected for a missing code
Where agents fit
- 1.Document extraction into structured intake
- 2.Missing-information detection before the first call
- 3.Prior-auth packet drafting
- 4.Scheduling outreach with scoped, redacted evidence
What stays human
- 1.Clinical decisions
- 2.Final submission to payers
- 3.Patient conversations that need care
Next step
Map your version of this process.
The opportunity audit replaces this hypothesis with your real process, your numbers and a ranked roadmap.