Business Challenge
This Health Network faced mounting operational pressures:
- High administrative overhead in patient intake, claims processing, and EMR documentation
- Delayed patient communication due to overwhelmed call centers
- Manual, error-prone processes in medical coding and insurance verification
- Clinical staff burnout from excessive documentation and note-taking tasks
Leadership recognized the need for scalable automation—without compromising patient safety or regulatory
compliance
Objective
Deploy a secure, HIPAA-compliant Generative AI solution to streamline non-clinical processes, assist
clinical staff, and improve patient experience.
Solution
Partnering with a healthcare, Our consulting firm implemented a suite of fine-tuned LLM-powered agents
integrated with their EMR (Epic), contact center platform, and claims processing system.
Key AI Use Cases Implemented
-
AI Medical Scribe (Clinical Assistant)
- Auto-generates SOAP notes during consultations
- Summarizes doctor-patient conversations in real time
- Syncs with EMR fields after physician approval
-
AI Front Desk Assistant
- Handles patient intake forms through conversational bots
- Verifies insurance details with integrated payer APIs
- Triages patient inquiries via phone and chat channels
-
Medical Coding Assistant
- Suggests CPT and ICD-10 codes from physician notes
- Highlights discrepancies to reduce denial rates
-
Claims Pre-Screening Bot
- Pre-validates claim documents for completeness
- Flags high-risk claims for manual review
-
Patient Engagement Bot
- Sends personalized post-visit instructions and follow-up reminders
- Answers FAQs around billing, prescriptions, and appointments
Results
| Metric |
Pre-AI |
Post-AI |
Improvement |
| Insurance Verification Turnaround |
48 hours |
<4 hours |
90% faster |
EMR Documentation Time
(per patient) |
14 mins |
4 mins |
71% reduction |
| Call Center First Response Time |
12 mins avg. |
2.5mins avg. |
79% improvement |
| Claim Denial Rate |
12% |
6.2% |
48% reduction |
Provider Burnout Score
(Surveyed) |
7.1/10 |
4.3/10 |
Significant relief |
- Estimated cost savings of $2.1 million/year from reduced manual workload
- Improved patient satisfaction scores by 20% within the first 6 months
Key Success Factors
- Compliance-first approach: All AI models hosted on private cloud with full HIPAA controls
- Human-in-the-loop validation: Clinicians retained final control over all outputs
- Cross-functional implementation team: Involving IT, clinical ops, legal, and billing from day one
- AI training & change management for doctors and administrative staff
“
The AI scribe has been a game-changer for our doctors finally letting them focus more on
patients than paperwork. And that’s the kind of technology healthcare truly needs."
Quote from
Chief Medical Officer
Next Steps
This leading Health Network is expanding GenAI usage to:
- Predictive risk modeling for chronic care patients
- AI-generated discharge summaries for post-acute facilities
- Multilingual patient communication using AI-powered translation models
