Our client is a cloud-based healthcare software company that provides electronic health record, practice management, patient engagement, and revenue cycle management solutions for independent medical practices.
Its appeal operations relied heavily on manual work, with each appeal taking two to four hours to process. Data was fragmented across systems, and the quality of appeal letters varied from case to case.
Manual errors in patient’s and coding data contributed to higher rejection rates and compliance risk while delayed submissions strained cash flow. High operating costs and 15-20% appeal drop-offs created further revenue leakage.
Our client engaged Emids to automate the appeal workflow end to end, standardize outputs, and establish a scalable, compliant operating model.
SOLUTION
Emids built a deterministic multi-agent AI pipeline to manage the appeal process end-to-end from intake through submission.
Template-driven letter generation standardized outputs across more than 12 denial scenarios and supported payer compliance. An abstraction layer stabilized system integrations and reduced dependency on API changes, while multi-office and multi-credential processing, deduplication, and batch handling enabled the workflow to operate across a complex delivery environment.
AWS S3 and PostgreSQL provide document storage, audit trails, and execution tracking. Docker, logging, and real-time pipeline monitoring give operations teams the controls required to run and manage the workflow in production.
OUTCOMES
The automated workflow reduced processing time by 95%, from as much as four hours per appeal to about ten minutes. Our client can now submit appeals the same day, 30–60 days earlier than under the previous process. Earlier submission starts the review and recovery cycle sooner, reducing delays in collecting revenue from denied claims and improving cash flow.
