Midwest Healthcare Network, Healthcare · Multi-site practice, 70% of routine claims processed without human touch.
A multi-site healthcare network had normalized a claims-processing bottleneck for three years. We diagnosed the workflow, installed a routing agent on top of their existing clearinghouse, and handed the team a documented system they now run themselves.
70%
Routine claims auto-processed
3 yrs
Bottleneck eliminated
4 wks
From Diagnostic to live agent
The state of the business before
Billing staff were re-keying claim data across three systems and chasing the same denial reasons every week. Leadership had attempted two prior automation projects that stalled at the integration step.
The specific workflow and the named platforms
An ingestion agent classifies inbound claims, validates payer-specific fields, submits clean claims directly, and routes only true exceptions to a human reviewer with the relevant context attached.
Quantified against the baseline
Within the first full month, 70% of routine submissions cleared without human touch. Staff time shifted from re-keying to exception handling, and denial rework dropped meaningfully. The team operates the system without our involvement.
The Diagnostic paid for itself in the first meeting. They identified a claims-processing bottleneck we had normalized over three years. The agent they built now handles 70 percent of routine submissions without human touch, and our staff actually prefers the new workflow.