Overview
A multi-location orthopedic practice group was losing patients to long wait times and a cumbersome paper-based intake process. Front desk staff spent 15+ minutes per patient on manual data entry, and no-show rates were climbing because patients weren’t completing pre-visit paperwork.
We built a HIPAA-compliant conversational AI bot that handles the entire intake flow — from appointment confirmation and demographic collection to insurance verification and clinical pre-screening questionnaires. Patients interact via SMS, web chat, or a patient portal link sent 48 hours before their visit.
How It Works
1. Pre-Visit Engagement
Automated appointment reminders via SMS 48hrs and 24hrs before visit. A conversational intake flow collects demographics, insurance info, reason for visit, and medical history — all before the patient arrives.
- Smart branching logic adapts questions based on visit type (new patient vs. follow-up, surgical consult vs. routine)
- Multilingual support (English, Spanish) with natural language understanding
- Conversational flow feels natural, not like filling out a form
- Patients can pause and resume at any time
2. Insurance Verification & Eligibility
Real-time eligibility checks against major payers via Availity and Change Healthcare APIs. The bot automatically verifies benefits and flags issues before the patient walks in the door.
- Automated benefit verification: copay amounts, deductible status, prior authorization requirements
- Flags coverage gaps or expired policies before the patient arrives
- Staff dashboard shows verification status for all upcoming appointments
- Reduces claim denials from eligibility-related errors
3. Clinical Pre-Screening
Condition-specific questionnaires (pain scales, injury history, surgical history, medication lists) are presented conversationally and the structured data output feeds directly into the practice’s EHR.
- Structured data output feeds directly into the practice’s Athenahealth EHR
- PHI encrypted end-to-end with AES-256; data at rest in HIPAA-compliant AWS infrastructure
- Consent capture with e-signature and timestamp for compliance records
- Clinicians review completed questionnaires before the visit begins
Architecture & Infrastructure
Conversational AI
Amazon Lex + custom Lambda fulfillment, GPT-based natural language fallback
Integration
Athenahealth EHR (HL7 FHIR), Availity (eligibility), Twilio (SMS/voice)
Security
AES-256 encryption, PHI tokenization, BAA-covered AWS infrastructure
Monitoring
Conversation analytics dashboard, completion rates, drop-off tracking
Performance
Intake Completion Rate
87% (vs. 52% paper)
Average Conversation Duration
8 minutes
Insurance Verification
<30 seconds
Patient Satisfaction Score
4.6/5.0
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