Production AI agent programs for enterprise leaders

Problem. Patient access capacity is consumed by routine booking traffic, capping the volume a health system can serve without adding headcount.

Agent design. Voice agent on Amazon Connect and Lex authenticates the patient, reasons over provider availability and scheduling rules, and writes the booking directly into the EHR — escalating to a human the moment a clinical question appears.

Outcome. Scheduling work completes end to end in the call, with clinical and exception traffic routed to patient-access staff with full context.

Acts in. EHR scheduling · Patient identity · CCaaS

Problem. Billing and coverage conversations require staff to reconcile four to six systems live, which slows resolution and creates compliance exposure.

Agent design. Assist agent retrieves balance, coverage eligibility and script-safe payment-plan options in real time and proposes the compliant next step for the representative to confirm.

Outcome. Consistent, compliance-safe financial conversations resolved on the first contact. The representative approves every financial commitment before it is offered.

Acts in. Billing / RCM · Eligibility · Payment plans

Problem. Prior auth is payer-specific, multi-step work that consumes clinical time and delays both care and reimbursement.

Agent design. Multi-agent system: an intake agent assembles the clinical packet, a payer-rules agent applies the right criteria, a submission agent files it, and a follow-up agent tracks status — clinicians approve before submission.

Outcome. Submission and chasing run autonomously; clinical staff review exceptions only.

Acts in. EHR · Payer portals · Utilization management

Problem. Clinical, policy and coding content is scattered across intranets, PDFs and legacy systems, so patient-facing agents cannot be trusted with an answer.

Agent design. Unified semantic index with PHI-aware access controls, freshness signals and evaluation guardrails, exposed as a retrieval tool to clinical and operational agents.

Outcome. Every clinical and operational agent answers from one governed source, so care teams stop verifying answers by hand.

Acts in. Intranet and document stores · Legacy knowledge bases · Access control

Problem. Fax, PDF and portal records arrive faster than staff can classify them, delaying care decisions and billing.

Agent design. Agent classifies, extracts and indexes documents into the EHR with confidence thresholds, and routes only low-confidence items to human review.

Outcome. Common document types index straight through; humans see exceptions only.

Acts in. EHR · Document capture · Fax and portal intake

Problem. Denial rework is revenue-critical yet capacity-bound, so recoverable dollars are written off when queues grow.

Agent design. Agent classifies denials, tags root cause, prioritizes by recoverable value and drafts appeal packets with supporting documentation for reviewer approval.

Outcome. More recoverable denials are worked, with reason coding that feeds prevention upstream.

Acts in. Billing / RCM · Payer remittances · Appeals workflow

Problem. Missing charges, coding gaps and denial risk sit across disconnected EHR, billing and payer systems, extending days in AR.

Agent design. Agent prioritizes workqueues by recoverable value, drafts coding clarifications and flags denial risk against payer rules before the claim goes out, with coder approval.

Outcome. Cleaner claims leave the building and cash converts faster with fewer manual touches.

Acts in. EHR · Billing / RCM · Payer rules

Problem. Self-pay and balance-after-insurance accounts are expensive to reach and carry patient-billing compliance risk on every contact.

Agent design. Voice and SMS agent authenticates the patient, presents policy-approved payment-plan options, takes payment within limits and transfers on any hardship or dispute signal.

Outcome. More balances resolved per outreach dollar, with a complete compliance record.

Acts in. Billing / RCM · Payments · Consent log

Problem. Scheduling, billing, portal help and referrals sit behind separate numbers, so patients repeat themselves and calls multiply.

Agent design. One agent authenticates once, reasons across EHR, RCM and knowledge sources, completes the request in whichever domain it belongs to and hands off with full context.

Outcome. Single-contact resolution across patient services and fewer repeat calls. Clinical questions and financial hardship cases escalate to staff with the record attached.

Acts in. EHR · Billing / RCM · Referral management

Problem. Idle block time is among the most expensive unused capacity in a health system, and manual rebooking cannot keep up with cancellations.

Agent design. Agent forecasts utilization, proposes block releases and fill lists, predicts likely bumps and executes rebooking once the scheduler approves.

Outcome. Higher utilization of high-cost capacity with less manual scheduling overhead.

Acts in. EHR scheduling · Block management · Capacity analytics

Problem. Patient-access centers are the capacity bottleneck for appointment volume, referrals and prep instructions.

Agent design. Kore.ai agent books and modifies appointments in the EHR, manages referral steps, sends prep and reminder messaging and applies HIPAA-aware guardrails throughout.

Outcome. More appointments are self-scheduled and kept, with fewer live-agent touches per booking.

Acts in. EHR scheduling · Referral management · Patient messaging

Problem. Authorization delays hold up care and reimbursement, and payer-specific rules make the work impossible to standardize manually.

Agent design. Kore.ai agent assembles submissions, applies payer rules, attaches required clinical documentation and tracks status, escalating exceptions to a clinical reviewer.

Outcome. Authorizations submit faster and fewer are denied for missing information.

Acts in. EHR · Payer portals · Clinical documentation