Your team makes the medical call. The paperwork can prepare itself.
Admissions, authorizations with their expiry watched, fee schedules per insurer and plan, an operating room with its kit, a pharmacy with its batches and collections that arrive with evidence. The whole circuit of a clinic in a system of your own, with the AI preparing the paperwork and a person signing whatever commits a patient or money.
Each insurer sets the validity of an authorization in its agreement.
The AI reads the reply, extracts the authorization and attaches it to the case.
A physician signs the medical act. Always.
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states of an authorization
requested · at the insurer · received · about to expire
0
checks before issuing
against the fee schedule and against the authorization
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payers per case
insurer · employer · private
0
clinical decisions from the AI
a physician signs the medical act
UNDER THE HOOD
It does not read medical records. It reads what the case needs to move forward.
Three moments where a clinic loses money and time today: the authorization requested at 3 a.m., the budget that does not match the approved letter, and the line the insurer is about to reject. In all three, the AI assembles the file and a person decides.
Sample lead
Raw lead comes in
Saturday, 02:40. Case #C-4471 (patient R.M., 54) is admitted through emergency at the North site. Active policy with Aseguradora Bitácora, Integral plan. Admissions opens the case; the physician on duty has already written the reason for admission and the initial course of action.
Eligibility
active policy, policyholder and relationship confirmed against the plan roster
File
report from the physician on duty + the insurer’s declaration form, already filled with the case data
Missing
the attending physician’s signature and the admission lab result are missing: they are flagged, not invented
Channel
Bitácora has no API: the request goes out through its clinic portal with a copy by email, carrying the case number
Watch
the reply arrives as a PDF; the AI extracts the authorization, attaches it to the case and schedules the alert before it expires
Score
0/100
Verdict from Claude
The request goes out complete in the middle of the night, and what is missing is written down. Who is treated and how was decided by the physician on duty, not by the system.
WHAT THE AI DOES HERE
Five concrete functions inside the clinic’s operation
None of them touches medical judgment. They assemble the file, cross tables, catch differences and draft; the signature, the medical act and anything that commits money stay with a person.
salud.solicitarClave()
The authorization request goes out assembled and complete
It takes the case opened at admissions, checks eligibility against the plan, assembles the medical report and the declaration form in that insurer’s format and sends it through its channel: portal, email or PDF. When the reply arrives it extracts the authorization, attaches it to the case and watches the expiry.
› input
Case #C-4471 · emergency · Aseguradora Bitácora, Integral plan · report from the physician on duty
› claude →
eligibility: active policy · policyholder confirmed · no premium arrears on record
file: medical report + the insurer’s declaration form
missing items flagged: attending physician’s signature · admission lab result
channel: clinic portal + email copy carrying the case number
on reply: authorization attached to the case and an alert scheduled before expiry
LIVE SYSTEM · Clínicas Latitud
This is what it looks like inside an AI-operated system — and how it is governed.
Clínicas Latitud is a network of four sites. Its clinical-administrative workstation works by patient and by shift: the AI prepares the administrative and operational work, and a person decides anything clinical.
System modules
- 01Admissions and codes
- 02Bed census
- 03Medical schedule
- 04Operating room and kits
- 05Pharmacy
- 06Pre-billing
- 07Adjustments and collections
- 08Indicators and access
Boosty Standard for Operating with AISimulated AI · demo data
The same case, two fee schedules, two different invoices
A fee schedule is the rate agreed with each insurer and each plan. The AI reads what was done and codes it against that plan’s schedule: code, quantity and amount. Whatever the plan does not cover is never estimated — it is set aside for a person to discuss with the patient.
Case of the day
What was done
Emergency admission with six hours of observation at the North site: emergency consultation, electrocardiogram, admission lab panel and intravenous medication.
Switch the case or the plan
Fee schedule applied
Broad schedule: private room and prosthetic material inside the plan.
| Code | Line | Qty | Amount |
|---|---|---|---|
| BI-1102 | Emergency consultation covered by the plan | 1 | $38.00 |
| BI-2041 | Electrocardiogram with reading covered by the plan | 1 | $45.00 |
| BI-3206 | Admission lab panel covered by the plan | 1 | $68.00 |
| BI-1140 | Observation per hour × 6 covered by the plan | 6 | $96.00 |
| BI-5012 | Intravenous medication · dispensed by pharmacy covered by the plan | 3 | $52.00 |
To the insurer
$299.00
Patient co-pay
$0.00
Outside the schedule
$0.00
The AI codes against that plan’s live fee schedule. The head of insurance and billing confirms before sending.
IN THE SYSTEM · PRE-BILLING
The difference with the fee schedule shows before billing.
Every case against its insurer’s fee schedule and the authorization that covers it. The AI proposes the correction; a person accepts it and issues.
Real screenshot of the system · demonstration data
The room goes in with a kit and comes out with actual use
Every scheduled procedure comes with the kit from the published protocol, reserved in pharmacy with its batch. When the surgical act closes, what was planned is compared with what was actually used: that difference is what gets lost today between the room and the invoice.
Schedule for the day
Pick a procedure
Procedure kit
act closed| Supply | Batch | Plan | Actual | Diff. |
|---|---|---|---|---|
| Disposable trocar | L-8841 | 3 | 4 | +1 |
| Absorbable suture | L-7720 | 6 | 6 | 0 |
| Surgical sponge | L-6903 | 10 | 12 | +2 |
| Sterile gloves (pair) | L-5512 | 8 | 8 | 0 |
| Scalpel blade | L-4410 | 2 | 2 | 0 |
Fees by role
An unrecorded consumable stops the closing of the surgical act. The difference feeds the pre-invoice and the pharmacy restock, with the reason written by the scrub nurse.
What is operated, with what technique and when it closes is decided by the surgical team.
IN THE SYSTEM · OPERATING ROOM
Every surgery with its authorization and its kit, on the room’s timeline.
The schedule by room shows live whether the authorization is in force and whether the kit is complete. Confirming the schedule is up to coordination; clinical calls are the surgeon’s.
Real screenshot of the system · demonstration data
A clinic’s inventory is measured in batches and dates
Knowing how many units are left is not enough: you need to know which batch they belong to, when they expire and which service is running short. The AI watches all three at once and assembles the purchase request; pharmacy approves it.
| Supply | Service | Batch | Expires | On hand | Minimum |
|---|---|---|---|---|---|
Surgical sponge in range | Operating room | L-6903 | 12/11in 49 days | 240 | 120 |
Disposable trocar below minimum | Operating room | L-8841 | 03/12in 70 days | 14 | 20 |
Absorbable suture in range | Operating room | L-7720 | 14/03in 172 days | 96 | 60 |
Sterile gloves (pair) below minimum | Operating room | L-5512 | 08/09in 350 days | 74 | 90 |
Local anesthetic near expiry | Emergency | L-5203 | 18/10in 24 days | 36 | 30 |
Saline solution 0.9% stockout | Emergency | L-4402 | 30/01in 129 days | 0 | 60 |
Intravenous antibiotic in range | Inpatient | L-7208 | 05/11in 42 days | 48 | 40 |
Intravenous analgesic near expiry | Inpatient | L-7311 | 21/10in 27 days | 52 | 45 |
Sterile dressing in range | Outpatient | L-6115 | 22/05in 241 days | 310 | 150 |
Laboratory reagent in range | Laboratorycold chain | L-3390 | 27/10in 33 days | 18 | 15 |
Gel sample tube below minimum | Laboratory | L-3402 | 16/06in 266 days | 9 | 40 |
Dispensing always runs against a medical order and is deducted from the dispensed batch, not from the total.
Proposed purchase request
below the service minimum
L-8841 · 03/12
below the service minimum
L-5512 · 08/09
batch near expiry: restocked before it is pulled
L-5203 · 18/10
stockout: the service has no units left
L-4402 · 30/01
batch near expiry: restocked before it is pulled
L-7311 · 21/10
below the service minimum
L-3402 · 16/06
IN THE SYSTEM · PHARMACY
The lot that expires first goes out first.
Lots with their expiry traffic light, fridges with their temperature readings and proposed transfers between sites. Dispensing is done by the pharmacist, against the signed medical order.
Real screenshot of the system · demonstration data
SAME ENGINE, A DIFFERENT KIND OF CENTER
The service changes. The circuit with the payer does not.
Authorization, fee schedule, evidence, adjustment and account status exist in any center that bills a third party. What changes is what happens between the approval and the invoice.
Signals specific to the industry
Invoicing is not collecting. Between the two sits the adjustment
Each insurer has its own account statement, its own deadline to deliver evidence and its own medical audit. Whatever comes back adjusted is answered with the evidence in hand and within that agreement’s deadline; once the deadline passes, the discussion is over.
Account status per insurer
- Invoiced
- $186,400
- In audit
- $42,300
- Adjusted
- $9,800
- Collected
- $134,300
Receivables aging
- Invoiced
- $121,750
- In audit
- $30,500
- Adjusted
- $14,200
- Collected
- $77,050
Receivables aging
- Invoiced
- $94,200
- In audit
- $18,700
- Adjusted
- $21,400
- Collected
- $54,100
Receivables aging
- Invoiced
- $63,900
- In audit
- $11,200
- Adjusted
- $4,600
- Collected
- $48,100
Receivables aging
Deadlines per agreement
Deadlines are in business days and each insurer sets them in its agreement. The system does not invent them: it loads them and watches them.
| Claim notice | Evidence delivery | Adjustment response | |
|---|---|---|---|
| Bitácora | 10 | 20 | 15 |
| Almendro | 7 | 15 | 10 |
| Sextante | 10 | 30 | 12 |
| Parhelio | 5 | 20 | 10 |
business days
Adjustment cycle
Pick an adjustment
Reason from the medical audit
Insufficient evidence on the operating room lines: the signed operative report is missing.
- Operative report signed by the surgeon
- Medical order for the procedure
- Kit consumption recorded in the room
- Authorization with its number and validity
Draft response
The signed operative report and the kit consumption record are attached; both support the four objected lines. The procedure was performed within the validity of the authorization and with the codes of that plan’s live fee schedule.
Time left
6 business days
THE SAME FACT · TWO COMPANIES
One adjustment read against the same fee schedule.
The insurer objects to the third hospital day; the clinic answers with the discharge report and the bed log. It is not an opinion: it is the gap between what was billed and what the authorization approved.
CL-7706 · S-5520Clínicas Latitud · bills it
CL-7706 · S-5520Seguros Latitud · audits it
Real screenshot of the system · demonstration data
The same case, seen by seven different people
Health data is not protected with a promise: it is protected by deciding which field each role sees and keeping access on the record. The physician sees their patients’ records; admissions sees the reason; the insurer sees only the case and what supports the invoice.
Who is looking
Case file #C-4471
view of Attending physician
- Patient identitysees in full
R.M. · 54 · policyholder
- Document and policysees masked
policy active · document not shown
- Reason for the visitsees in full
emergency admission · six hours of observation
- Diagnosissees in full
written and signed by the physician on duty
- Medical report for the requestsees in full
full signed report, as the insurer requires
- Full medical recordsees in full
history, notes and patient progress
- Authorization and validitysees masked
authorization state, without the number
- Lines and amountsdoes not see this field
— — —
- Supply consumptiondoes not see this field
— — —
What the model receives
Toggle the permission and watch what enters the model
- ·case: #C-4471
- ·site: North · plan: Bitácora Integral
- ·procedures: 5 coded lines from the schedule
- ·authorization: 88-4471 · valid: 12/10
- ·identity: outside the context
- ·diagnosis: outside the context
Access trail
No access to diagnosis recorded for this case.
The rule that is not negotiable
The AI never sees identity and diagnosis together without an explicit, recorded permission. With permission, the diagnosis enters; the identity stays out and the case travels by its code.
What the AI never does
- Write or change a diagnosis.
- Order, stop or modify a treatment.
- Authorize a discharge or an admission.
- Issue an invoice or approve a payment.
- Publish a clinical protocol without a physician’s signature.
IN THE SYSTEM · ACCESS LOG
Clinical data opens with a reason and the access expires.
Who opened clinical data, when and why. Identity and diagnosis never appear together without a recorded reason, and compliance reviews the openings the auditor suspended.
Real screenshot of the system · demonstration data
IN THE SYSTEM · ON A PHONE
The codes board wherever the admissions person is.
The workstation is designed for the reception tablet and adapts to a phone: portals move to a scrolling bar and the patient band fits on one line.
Real screenshot of the system · demonstration data
WITH WHAT YOU ALREADY USE
The system connects to the clinic’s reality
Most insurers expose no API: the work happens through portals, email and PDFs. That is exactly where the AI reads the reply and attaches it to the case, with nobody retyping anything.
Claude · Anthropic
EngineReads the insurer’s reply, codes against the fee schedule, assembles the kit and drafts the response to an adjustment. It decides nothing clinical.
Insurer portals
Authorizations, account statements and adjustments live in portals with no API. They are integrated through email and PDF, with the case number as the key.
WhatsApp Business
Appointment confirmation, pre-op reminder and notice of missing documents, with the conversation attached to the case.
Supabase · Postgres
Data lives in your database, with per-site and per-role permissions at row level and every access to the record recorded.
Google Workspace
Email and calendar as a channel: the insurer’s reply arrives there and the operating room is scheduled there.
Make · n8n
An authorization received triggers the expiry alert; a batch near expiry triggers a purchase request; nothing is issued on its own.
Frequently asked questions about systems for clinics
The medical record belongs to the physician and their patient. The system stores it with recorded access — who opened it, when and for what reason — and shows it in full only to the attending professional. Admissions sees the reason for the visit; insurance and billing see the case and its lines, not the record. The AI works on the administrative file of the case, not on the full record.
No, and it is written as a rule of the system, not as good intentions. The AI prepares requests, codes against the fee schedule, assembles kits, pre-bills and drafts responses to adjustments. Diagnosis, course of treatment, orders and discharge are signed by a physician. If a flow tries to push a clinical decision, it stops and it lands in the audit log.
The case and what supports the invoice: the medical report the insurer itself requires to grant the authorization, the fee schedule lines and the evidence for each line. It does not receive the full medical record or internal notes. Whatever leaves toward a third party is recorded: what was sent, who sent it and why.
In your own database, with per-site and per-role permissions at row level, audited access to the record and retention defined by data type in the information policy. The AI receives the fragment needed for the task: identity and diagnosis never travel together without an explicit, recorded permission. The applicable legal framework depends on the country each site operates in and is reviewed when the scope is defined.
That is the normal case, and it is where most of the value shows up. It integrates where the work already happens: the clinic portal, email and PDFs. The AI reads the reply, extracts the authorization or the reason for the adjustment and attaches it to the case, keeping the original document as evidence. If an API appears later, the system uses it without rebuilding the circuit.
Yes. Each site has its insurers, its fee schedules, its pharmacy and its billing, and management sees the network consolidated. Permissions are per site: whoever works in one does not see cases from another unless their role requires it. Currency, tax format and agreements are configured per entity.
It is defined in the assessment. The model has three parts: setup, a monthly fee and a variable cost per processed volume. The scope — which module comes first, how many sites, how many insurers — comes from what we see in your operation. Book 30 minutes and we give you the range in writing.
A WORD FROM THE FOUNDER
“In a clinic the bottleneck is almost never medical. It is an authorization that expired, an operative report that was never attached and an invoice that came back rejected three weeks later.”
When you sit down with the admissions and billing teams, the list is always the same: the authorization that was requested but nobody knows the status of, the fee schedule that lives in a spreadsheet someone updated on their own, the supply used in the operating room that never made it to the invoice, the adjustment whose deadline passed unanswered.
None of that is medicine. It is paperwork with deadlines, and paperwork with deadlines is exactly what a system with AI does well: read, cross-check, warn and leave the file assembled. That is why the rule of this system fits in one line: the AI prepares the administrative and the operational, and never decides the clinical.
If you want to see your own circuit — from admission to authorization, from authorization to invoice and from invoice to payment — book 30 minutes with me. We take a real case of yours and walk it end to end.
Gabriel Montiel
CEO · Boosty Digital
START
How many insurers do you bill today?
Book a 30-minute assessment. We walk the full circuit — admission, authorization, operating room, pre-invoice, adjustment and collection — and tell you what we would build first.