Explore GenHealth Workflows
Automate patient intake, eligibility verification, prior authorization, resupplies, and more. GenHealth handles complex healthcare workflows end-to-end.Automate 80-100% of manual tasks
Reduce admin burden by over 80%
Works across multiple applications
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Workflow
Intake
Turns every referral channel into a structured order. Ingests faxes, e-prescribe, uploads, and email attachments; OCR + extraction produces demographics, primary and secondary insurance, ICD-10s, CPT/HCPCS, products, and ordering provider with NPI — each field cited to its source page. On approval (or auto for high-confidence orders), creates patient, insurance, prescription, and order records in your EMR or billing system.
Intake/case IX-8842
SOURCE FAX·EMR EPIC·03:14:22
intake.genhealth.ai /case-8842 / scan / sleep-rx.pdfcase-8842 / record
Live01 · Scan→02 · Record
Page 1 / 2
FAX · IN03/04/2026
Sleep Rx · CPAP
PatientAbe Lincoln
DOB02 / 12 / 1947
OrderCPAP, full setup
DxG47.33 — OSA
PlanBCBS TX · 847-21
ProviderL. Patel, MD
Scanning · 34 fields detected
Order · auto-filedSource · sleep-rx.pdf
CPAP Therapy
Member 847-21 · BCBS TX · MRN 789012
PatientAbe Lincolnp.1 · ln 1
DOB1947-02-12p.1 · ln 2
CPTE0601p.1 · ln 3
ICD-10G47.33p.1 · ln 4
PayerBCBS TX · eligible ✓p.1 · ln 5
Citation · sleep-rx.pdf, p.1, ln 4“Dx: G47.33 — OSA, recommend CPAP, full setup.”
✓
Claim filed837P · BCBS TX · ack 200
Workflow
Medical Necessity
Selects the right LCD, NCD, commercial guideline, or customer SOP and evaluates clinical documentation criterion by criterion. Output: met vs. unmet criteria with quoted evidence, specific documentation gaps, recommended next actions, and a verdict — Qualified, Needs Docs, or Don’t Submit. Scores a single referral or the full open queue.
Prior auth/PA-2261
METFORMIN·T2D-04·03:14:22
priorauth.com/case/PA-2261
LiveMatch policy/Decision/Submit
EMR · Chart
847-21chart · 12 mo34
APPROVED
Prior
Authorization
Request
Authorization
Request
Payer Policy
BCBSIs the patient diagnosed with type 2 diabetes mellitus?
Does the patient have an A1C of 7.5% or greater?
Has the patient experienced a contraindication to metformin?
3 / 3 criteria metApproved
Workflow
Eligibility
Selects the right path per carrier — API, clearinghouse, or portal RPA — and parses raw responses into structured benefits (deductible, coinsurance, out-of-pocket, plan rules). Writes back to the EMR and attaches the eligibility PDF to the patient record. Runs embedded in intake or standalone: ad-hoc, scheduled, or event-driven.
Eligibility/case EL-4719
PAYER BCBS TX·MEMBER 847-21·03:14:22
healthplan.com/
Livelogineligibility/checkeligibility/result
Login/Patient info/Result
01 · Sign in
HealthPlan Portal
Provider workspace · BCBS TX
Email
genhealth@example.com
Password
●●●●●●●●●●
Sign in →
02 · Patient lookup
Eligibility Check
Verify member coverage with payer · real-time
Patient information
First name
Abe
Last name
Lincoln
MRN
MRN123456
Check eligibility →Checking…
03 · Result
Eligibility Result
Returned by BCBS TX · 270/271 in 1.2s
Abe Lincoln
MRN MRN123456
Active coverage
Member has coverage
Effective Jan 1, 2025 — Dec 31, 2025
Done ↵
Workflow
Prior Authorization
Assembles payer-specific packets from intake and qualification artifacts and submits via Availity, CareCentrix, Carelon, and direct payer portals. Polls for status; ingests approvals, denials, and documentation requests; routes requests back into intake; notifies the team in Slack/email/EHR; and logs auth numbers and units to the order with a complete audit trail.
Prior auth/PA-2261
METFORMIN·T2D-04·03:14:22
priorauth.com/case/PA-2261
LiveMatch policy/Decision/Submit
EMR · Chart
847-21chart · 12 mo34
APPROVED
Prior
Authorization
Request
Authorization
Request
Payer Policy
BCBSIs the patient diagnosed with type 2 diabetes mellitus?
Does the patient have an A1C of 7.5% or greater?
Has the patient experienced a contraindication to metformin?
3 / 3 criteria metApproved
Workflow
Resupplies
For each eligible patient: checks payer-specific resupply policy, re-verifies eligibility and plan changes, reviews CMN status and prior-order history, refreshes required documentation, creates the compliant order with attachments, and flags renewals due before shipment. Keeps a per-cycle trail that proves Medicare and commercial compliance on demand.
Resupply/RX-7714
METFORMIN·90-DAY·03:14:22
resupplies.com/orders/RX-7714
LivePlan/Schedule/Ship
Patient Prescription
847-21Rx · active
Metformin 500mg
NDC 0093-1048-01 · oral
Sig
1 tab BID
Days supply
90 days
Quantity
180 tabs
Refills
3 of 3
Ship to
Abe Lincoln
1600 Pennsylvania Ave NW
Washington, DC 20500
Washington, DC 20500
last fill Dec 128 days remaining
Resupply Schedule
2026January ship · Jan 1
90X
February ship · Feb 1
90X
March ship · Mar 1
90X
April ship · Apr 1
90X
Start date
Jan 1, 2026
Cadence
Every 30 days
Window
8–11am
shipments scheduled0 / 41 / 42 / 43 / 44 / 4 ✓
Order →
Ordered
Workflow
Stock & Bill
For clinics that stock DME and dispense at the point of care: GenHealth reads the handwritten dispense slip, structures the order against your inventory, and files a clean 837P claim — without anyone re-keying anything into Brightree or your billing system.
Workflow
Medical Billing
GenHealth AI automates medical billing submissions across the RCM continuum between providers and plans within existing EHRs and software.
Workflow
Referrals
GenHealth can automate referral tracking and follow-up actions within this workflow using AI to ensure timely communication and enhance user engagement.
Intake/case IX-8842
SOURCE FAX·EMR EPIC·03:14:22
intake.genhealth.ai /case-8842 / scan / sleep-rx.pdfcase-8842 / record
Live01 · Scan→02 · Record
Page 1 / 2
FAX · IN03/04/2026
Sleep Rx · CPAP
PatientAbe Lincoln
DOB02 / 12 / 1947
OrderCPAP, full setup
DxG47.33 — OSA
PlanBCBS TX · 847-21
ProviderL. Patel, MD
Scanning · 34 fields detected
Order · auto-filedSource · sleep-rx.pdf
CPAP Therapy
Member 847-21 · BCBS TX · MRN 789012
PatientAbe Lincolnp.1 · ln 1
DOB1947-02-12p.1 · ln 2
CPTE0601p.1 · ln 3
ICD-10G47.33p.1 · ln 4
PayerBCBS TX · eligible ✓p.1 · ln 5
Citation · sleep-rx.pdf, p.1, ln 4“Dx: G47.33 — OSA, recommend CPAP, full setup.”
✓
Claim filed837P · BCBS TX · ack 200
Workflow
Claim Review
Reviews each outgoing claim against Medicare and commercial requirements: code combinations, modifiers, units, documentation linkage, payer edits, and NPI/supplier integrity. Submits under your supplier number through your designated billing/EMR so reimbursements flow to you. Non-compliant claims route back into the front-end workflow for correction.
Workflow
Posting
Ingests remittance feeds and posts payments, adjustments, and denial codes against original claims. Reconciles posted amounts to submitted claims; surfaces variances, underpayments, and unposted balances; and triggers secondary/tertiary follow-up where COB applies. Deposit-posting integrations for Brightree today, with parallel flows for NikoHealth and other systems.
Workflow
Claims Follow-Up
Structured follow-up on outstanding claims using payer-specific aging thresholds: status checks via API or portal, escalations, and resubmissions where appropriate. Cadence is configured per payer to match actual response patterns, not a generic schedule. Every claim reaches paid, written off, or routed to appeal.
Workflow
Denials
Targets 90+ and 120+ aging buckets, Medicaid crossover, and categories surfaced by an A/R diagnostic. Diagnoses the denial reason from the ERA/EOB, regenerates corrective documentation via upstream agents, submits the corrected claim or appeal, and tracks each to terminal resolution. Monthly reporting by payer, bucket, and category.
Workflow
Analytics & Reporting
Monthly performance reporting on clean claim rate, first-pass acceptance, denial rate by payer and category, DSO, A/R aging, recovery on prior-period A/R, audit dispositions, and resupply capture rate. On-demand reporting and executive dashboards so leadership has the same visibility as the ops team.