Home Health Agency: Operational Workflow Automation
We built an end-to-end automation ecosystem that manages the heavy lifting of claims authorization, referral intake, and patient onboarding—while also offering a friendly chatbot to handle everyday inquiries. This lets the agency's team focus on direct patient care, without getting bogged down by manual paperwork and repetitive admin tasks.
Texas-based Home Health Agency
Healthcare Services
Client Partner
A Texas-based home health agency committed to high-quality patient care and operational excellence, facing increased administrative burden due to growth in daily tasks.
The Challenge
As the agency expanded its patient base and referral network, several critical issues arose:
Manual Claims Authorization
- Gathering information from payer portals (e.g., Availity) was time-consuming.
- Coordinating with insurance companies often required repetitive data entry and back-and-forth correspondence.
Cumbersome Referral Management
- Referrals arrived through multiple channels (e.g., Careport or direct emails), lacking a standardized process to filter, sort, and assign new patients to the proper teams.
Inefficient Intake Process
- Manual review and entry of patient information led to errors and delays.
- Staff spent valuable hours calling or emailing patients and caregivers to confirm details, reducing time for more critical tasks.
Customer Inquiry Overload
- As patient numbers grew, so did routine inquiries—appointment scheduling, coverage questions, and caregiver availability—often tying up staff in repetitive interactions.
The agency sought to eliminate these inefficiencies without disrupting the quality of care they provided.
Our Solution
Automated Claims Authorization
- Portal Integration: A dedicated bot was built to interact with payer portals like Availity, extracting authorizations and coverage details.
- Real-Time Alerts: Staff received immediate notifications if any claim required special attention or additional documentation.
Referral Management Automation
- Centralized Referral Pipeline: All referrals—from Careport or direct channels—were funneled into a single dashboard.
- Rule-Based Sorting: The system automatically assigned new referrals to the correct department based on patient need, location, and care requirements.
Efficient Intake Process
- Electronic Onboarding: Implemented web-based forms and auto-populated templates, significantly reducing manual data entry.
- Data Validation: AI-powered checks flagged inconsistencies or missing fields to ensure accurate patient records.
Chatbot for Routine Inquiries
- 24/7 Inquiry Handling: A conversational AI chatbot answered common patient and caregiver questions, from scheduling to coverage details.
- Escalation to Staff: Complex queries were seamlessly handed off to staff, who now had more time for higher-value tasks.
The Impact
| Key Metric | Approx. Improvement |
|---|---|
| Claims Authorization | ~50% faster turnaround |
| Referral Capture | 100% centralization |
| Data Entry Errors | ~30% reduction |
| Patient Support | 24/7 inquiry resolution |
| Staff Time Savings | Notable reduction in admin hours |
By automating these core processes, the home health agency achieved ~50% faster verification and turnaround times for claims authorization, 100% centralized referral capture to reduce lost opportunities, ~30% reduction in data-entry errors through automated form filling and AI validation, 24/7 chatbot resolution of routine inquiries freeing staff for complex patient care, and notable operational cost savings through reduced labor hours spent on repetitive tasks. These improvements enhanced both operational efficiency and staff satisfaction while ensuring faster, more reliable patient onboarding—laying the groundwork for scalable growth as patient volumes continue to rise.
"The automation suite has transformed our daily operations. Our staff now spends significantly less time on paperwork and more time focusing on what matters most—quality patient care. The chatbot has been particularly valuable in handling routine inquiries, giving us back precious hours in our day."
Operations Director
Texas Home Health Agency
In a nutshell
We built an end-to-end automation ecosystem that manages the heavy lifting of claims authorization, referral intake, and patient onboarding—while also offering a friendly chatbot to handle everyday inquiries. This lets the agency's team focus on direct patient care, without getting bogged down by manual paperwork and repetitive admin tasks.
