Beacon Health
An AI second read that catches what the first one misses.
- Client
- Beacon Health
- Sector
- Provider ops · Bengaluru
- Engagement
- 5 weeks
- Type
- Client engagement
The problem
Beacon's billing team manually filed prior authorizations from faxed charts. Incomplete submissions drove a wave of denials, and every denied prior was revenue that aged out before anyone noticed.
What we built
- 01
Intake that reads the chart
Inbound faxes are OCR'd and structured. The agent extracts the procedure, diagnosis, and supporting evidence, then matches it to the payer's published policy reference.
- 02
A HIPAA-scoped tool budget
Every tool the agent can call is sandboxed and logged. PHI never leaves the boundary, and the immutable audit log, not the model, is the source of truth for compliance.
- 03
A human queue for the hard ones
When confidence is low or policy is ambiguous, the agent routes the case to a human with a one-paragraph summary and a link to the evidence. No silent guesses.
How we measured it
Share of priors fully automated, denial rate for incomplete submissions, and revenue per ops FTE, reviewed weekly with Beacon's RCM lead.