Solutions · Healthcare

Automate healthcare operations.
Focus on patients, not paperwork.

Avintra brings governed agentic AI to healthcare — from prior authorization and medical record summarization to claims, denials, revenue cycle, and patient access. Reduce administrative burden, speed up care, and protect revenue for payers and providers.

50%
Faster prior auth
through automated evidence gathering
40%
Fewer claim denials
with pre-submission validation
30-60%
Lower cost to collect
via AI-enabled revenue cycle
90%
Faster record summaries
with traceable AI extraction
USE CASES

Orchestrate AI agents across the healthcare lifecycle

From patient access and care management to claims, revenue cycle, and compliance — Avintra automates the workflows that determine healthcare performance.

PRIOR AUTHORIZATION

Prior Authorization & Care Management

Automate clinical evidence gathering, validate medical necessity against payer-specific rules, bundle complete documentation, and track approval status in real time. Payers and providers reduce delays and deliver care faster.

  • Clinical evidence collection and policy rule matching
  • Complete documentation bundling and submission
  • Real-time status tracking and stakeholder alerts
  • Gaps-in-care outreach and follow-up automation
CLAIMS & DENIALS

Claims Operations & Denial Prevention

Detect incomplete patient information, missing pre-authorizations, and credentialing gaps before claims are submitted. When denials occur, agents analyze root causes, draft compliant appeals, and orchestrate corrections.

  • Pre-submission validation and claim scrubbing
  • Denial root-cause analysis and appeal drafting
  • Overpayment and high-dollar audit support
  • Appeals and grievances turnaround tracking
MEDICAL RECORDS

Medical Record Summarization

Convert complex medical records into concise, citation-backed summaries with human review, template control, and measurable ROI. Clinicians and process owners get evidence-based outputs tuned to their workflows.

  • Structured summaries from unstructured records
  • Template-driven output for clinical and legal use
  • Human-in-the-loop review and feedback loops
  • Traceable citations and source references
REVENUE CYCLE

Revenue Cycle Management

Streamline the entire revenue cycle lifecycle — from patient access and eligibility verification through charge capture, billing, payment posting, and denials resolution. Accelerate cash flow and protect margins.

  • Eligibility verification and benefit discovery
  • Charge capture, coding, and billing automation
  • Payment posting and reconciliation
  • Denials management and collections support
PATIENT ACCESS

Patient Access & Scheduling

Simplify how patients enter and move through the care system. Automate scheduling, registration reminders, referral coordination, and post-visit follow-up across voice, chat, and web channels.

  • Appointment scheduling and rescheduling
  • Eligibility, registration, and consent workflows
  • Referral intake and coordination
  • Automated reminders and no-show outreach
COMPLIANCE & QUALITY

Compliance & Quality Reporting

Turn clinical and operational data into audit-ready evidence for HEDIS, STAR, HIPAA, and other quality programs. Track measures, identify gaps, and generate regulatory filings with full traceability.

  • Quality measure tracking and HEDIS/STAR support
  • Audit evidence collection and retention
  • Regulatory filing and compliance reporting
  • PII masking, consent, and access control
WHY AVINTRA FOR HEALTHCARE

Built for the safety, compliance, and speed healthcare requires

Healthcare-trained agents

Pre-built agents for prior auth, claims, denials, revenue cycle, and patient access — grounded in clinical and payer terminology.

EHR & payer system integration

Connect with Epic, Cerner, MEDITECH, Allscripts, payer portals, clearinghouses, and CRMs via native connectors and APIs.

HIPAA, GDPR, and DPDP ready

Role-based access, PII masking, encryption, consent management, and immutable audit trails for healthcare compliance requirements.

Live in weeks, not quarters

Start with one high-impact process — prior auth or denials — and scale across the revenue cycle and patient journey on the same platform.

Built for clinicians and patients

Conversational, multilingual interfaces for patients, providers, and staff across web, mobile, voice, and email channels.

Outcome-backed business case

Measure prior-auth turnaround, denial rate, cost to collect, cash acceleration, and patient satisfaction with built-in analytics.

Ready to reduce healthcare administrative burden?

Start with one high-impact process — prior authorization, denials, or medical record summarization — and scale across the care and revenue lifecycle on the same governed platform.