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Thoughtful Automation Inc. introduces a comprehensive AI-based operating system designed to automate and enhance various processes within the healthcare revenue cycle management (RCM) sector. The platform focuses on reducing operational costs, improving the speed of payments, and increasing overall efficiency by deploying AI agents to handle specific tasks traditionally managed by human teams. Below is a summary of the main features and capabilities as outlined in the company-authored content.

Key AI Agents and Their Functions:

• Eva (Eligibility Verification): Manages eligibility checks comprehensively, reducing error-related denials. Capabilities include voice-enabled calls to insurers for up-to-date coverage, bulk verification processes, and integration with various portals.
• Paula (Prior Authorization): Automates prior authorization tasks, ensuring accurate and timely submissions, real-time tracking, and intelligent appeals generation.
• Cody (Coding & Notes Review): Automates complex coding tasks, ensuring audit accuracy and efficient code assignment, thus minimizing errors and manual workloads.
• Cam (Claims Processing): Handles full claims processing automation including claims scrubbing and submission, reducing denials, and coordinating benefits.
• Dan (Denials Management): Analyzes and corrects claim denials automatically, using real-time insights to prevent and resolve denials swiftly.
• Phil (Payment Posting): Automates all payment posting tasks, including handling zero pays and notifying teams for manual interventions when needed.

Platform Capabilities:

Revenue Cycle Automation:

• Integrated AI Systems: The platform promises a significant improvement in RCM performance through seamless integration with existing systems, ensuring automation across eligibility, authorization, claims processing, and payment posting.
• Reduced Costs and Increased Accuracy: By reducing manual input and improving precision, the system reportedly achieves major reductions in claims denials and operating costs.

Revenue Intelligence:

• Data Analysis and Reporting: Utilizes intelligent data collection to generate insights and reports, aiding in strategic decision-making and improving financial outcomes.
• Customization and Scalability: The system allows tailored automation workflows adaptable to different organizational needs and scales.

Strategic Benefits:

• Comprehensive Automation: Aimed at unifying different systems and processes under one automated framework, thus reducing the need for multiple vendor solutions.
• Compliance and Security: Adheres to healthcare regulations, including SOC 2 Type II and HIPAA compliance, by ensuring data accuracy and secure handling of patient information.

Customer Impact and Integration:

• Reduction in Claim Denials and Operating Expenses: The automation is claimed to decrease claim denials by 75% and operating expenses by 95%, enhancing overall RCM effectiveness.
• Vendor Consolidation: With its universal integration capability, the Thoughtful platform aims to streamline vendor management, leading to cost savings and operational efficiency.

Thoughtful Automation offers these AI solutions across various healthcare applications, ensuring integration with popular EHRs and practice management systems, allowing organizations to achieve better outcomes, enhance patient care, and maintain competitive advantage in the healthcare sector.