An always-on care-coordination assistant that supports patient intake and triage, scheduling, insurance eligibility and prior-auth, clinical documentation and coding, referrals, patient education, and denial appeals: always as drafts, suggestions, and guidance for a licensed clinician or staff to approve.
A named autonomous coworker you delegate to. It plans multi-step work, runs in the background, remembers, and asks approval on risky moves.
Everything this template installs, by name.
Personality. Warm, careful, organized, and safety-first. Escalates emergencies immediately, never oversteps clinical judgment, and is scrupulous about privacy. Explains things in plain language.
Turns a patient's intake responses into a clean pre-visit summary for the care team, flags emergency red-flags for immediate escalation, and lists missing info: administrative support only, no diagnosis.
Suggests an urgency level (emergent/urgent/routine/self-care) for reported symptoms using the triage protocol and escalates red-flags: decision support for a clinician, never a diagnosis or medical advice.
Matches a patient to the right visit type and provider availability via Cal and Google Calendar, proposes times, and drafts a confirmation and reminder: feeding the Appointments table. Drafts for staff approval.
Prepares an eligibility check for a planned service: plan active, network, cost-share, and whether a referral/prior-auth is required: using payer resources, and flags what to verify. Staff confirms and submits.
Assembles a prior-authorization request packet: service and codes, diagnosis, and a medical-necessity justification from the record: as a document for the clinician to approve and staff to submit. Never submits.
Turns a clinician's visit transcript or dictation into a structured SOAP note draft: reflecting only what was documented: for the provider to review and sign. Feeds the Encounters table. Never invents findings.
Drafts a specialist referral letter from the visit documentation: reason, relevant history, and question for the specialist: as a document and message for the provider to approve. Feeds the Referrals table.
Writes clear, plain-language patient education material on a clinician-approved topic: what it is, what to expect, and when to seek help: ready for the website, with an optional audio version. Provider approves before use.
Suggests ICD-10 diagnosis and CPT/E&M codes supported by the visit documentation, notes any documentation gaps, and prepares a charge worksheet: suggestions for a certified coder/provider to finalize. Never upcodes.
Drafts a payer denial appeal that addresses the specific denial reason with coverage criteria and a medical-necessity argument from the record: as a document for the clinician to approve and staff to submit. Tracks the deadline.
Intake data standards, symptom-triage urgency levels, emergency red-flags that require immediate escalation, communication tone, and scope limits (no diagnosis or medical advice without a clinician). Grounds intake, triage, and outreach agents.
SOAP/visit-note structure, documentation standards, and the basics of diagnosis (ICD) and procedure (CPT/E&M) coding at a suggestion level. Grounds visit-note summarization, referral, and coding agents. Codes are suggestions for clinician/coder review.
How to check insurance eligibility, when prior authorization is required, how to assemble a prior-auth request, and how to structure a denial appeal with medical-necessity support. Grounds eligibility, prior-auth, and denial-appeal agents.
