Clinics where the authorization, the fee schedule and the deduction stop living in an inbox
Admissions with authorizations and letters of guarantee watched until they expire, a fee schedule per insurer and plan, operating rooms with their kit and actual consumption, and collections with deductions answered inside the deadline. AI prepares the administrative and operational work; clinical calls are made by a person.
4 insurers · 2 sites
Admissions · authorization board
- HC-4821M. R.Altamar · Executive plan
Surgery · cholecystectomy
Requestedsigned report + form
- HC-3190J. A.Vertiente · Corporate plan
Inpatient · 2 days
With the insurersent through its portal
- HC-5177L. P.Almenara · Family plan
Emergency · observation
Receivedkey extracted from the PDF
- HC-2408D. S.Ribera · Basic plan
Maternity · C-section
Validlinked to the case
Validity30 business days· per agreement - HC-6032C. M.Altamar · Executive plan
Knee arthroscopy
Expiringrenew or reschedule
Validity15 business days· per agreement
The AI reads the answer and extracts the key. The medical report is signed by a person. · demonstration data
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insurers
each with its own agreement, fee schedule and deadlines
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role-based portals
admissions · physician · OR · billing · patient
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file per case
authorization, fee schedule, consumption and supporting docs together
L0
clinical decisions
AI prepares the paperwork; the physician decides
THE RULE THAT GOVERNS THE SYSTEM
The AI prepares the administrative and the operational work. Clinical decisions are made by a person.
Prepared by the AI
Authorization requests, reading the insurer’s answer, coding against the fee schedule, pre-billing and draft responses to deductions.
Decided by a person
Diagnosis, indication, treatment plan and discharge. The medical report is signed before it leaves.
Written down either way
Who signed, who sent, what the AI read and which document backs each line.
THE PROBLEM
Five frictions any clinic billing insurers already knows
If you treat patients from more than one insurer, the bottleneck is not clinical: it is administrative.
The authorization is requested by email and the answer stays in the email
Admissions puts together the signed medical report and the declaration form, sends them through that insurer’s channel and waits. The answer comes back as a PDF, an email or a note inside the insurer’s portal. Someone has to open it, read it and copy the authorization into the case. If nobody copies it, the patient is admitted without one or the surgery is postponed that same morning.
The letter of guarantee has a validity period and nobody watches it
Depending on each insurer’s agreement, the letter expires: in one agreement, fifteen business days, thirty for maternity. If the patient is rescheduled, it has to be requested again. Nobody notices until the insurer rejects the invoice for an expired authorization.
The fee schedule lives in a file per insurer and per plan
Every insurer agreed its own table: consultation, inpatient stay, surgery, pharmacy, professional fees per role. Whoever builds the estimate opens the file they believe applies. The gap between what was agreed and what was billed shows up weeks later, when the deduction arrives.
The deduction arrives with a deadline and the answer is built from scratch
The medical audit questions one line and asks for supporting documents: report, operative note, pharmacy consumption, surgeon’s signature. Collecting them takes days and the clock runs in business days. By the time everything is together, the window has sometimes closed and the line is written off.
The operating room and the pharmacy are kept apart from the case
The procedure kit is on one sheet, actual consumption on another and lot numbers with their expiry date on a third. Nobody knows whether what was used in theatre is what was billed, or which supply expires this month, until it is missing during the procedure.
THE SOLUTION
One system, five portals, each role seeing only its own work
Admissions moves authorizations. The physician works the record. Theatre and pharmacy see the kit and the lot. Billing sees fee schedule and deduction. The patient sees their case, without internal jargon.
Users
Admissions and patient-facing staff
Access to
Case, coverage, authorization and administrative documents. Not the full clinical detail.
Sees on screen
Authorization board by status (requested, with the insurer, received, valid, expiring), the channel each request went out through, and missing data flagged before sending.
Admissions portal
Today’s authorizations by status
Admissions works with coverage and paperwork. Clinical detail is not on this screen.
EXPLORE THE SYSTEM
Four modules, clickable before we talk
No screenshots: these are the four modules your clinic operates every day, with demonstration data. Insurers, plans and patients are fictional; the flow is the real one.
The authorization cycle, from the request to its expiry
The case assembles the request with the signed medical report and the declaration form, sends it through that insurer’s channel and waits. When the answer arrives — email, PDF or portal — the AI extracts the key, the validity and the authorized amount, cross-checks them against the case and keeps the original document as evidence.
- Missing data flagged before sending, not after the rejection
- The medical report goes out only with the physician’s signature
- Validity per agreement, with an alert before it expires
- Rescheduled past the validity: the case requests it again
↓ Interactive · demo data
Case HC-5177 · L. P.
Laparoscopic cholecystectomy
Aseguradora Altamar · Executive plan · North site · theatre
Authorization cycle
Case opened at admissions
Scheduled surgery. The case carries its procedure, attending physician and site.
- Patient
- HC-5177 · L. P.
- Procedure
- Laparoscopic cholecystectomy
- Payer
- Aseguradora Altamar · Executive plan
- Owner
- Attending physician · Dr. A. P.
The same procedure, priced against each agreement
Each insurer and plan agreed its own table: consultation, inpatient stay, surgery, pharmacy and fees per role. The case becomes coded lines against that table, and what was estimated is compared with what the letter of guarantee authorized — before anyone operates and before anyone bills.
- One live fee schedule per agreement, with its validity and history
- Lines above the agreed rate flagged in the estimate
- Lines the plan does not cover, written into the patient’s estimate
- The gap is settled before billing, not in the deduction
↓ Interactive · demo data
Fee schedule and estimate
Laparoscopic cholecystectomy · case HC-5177
| Code | Fee-schedule line | Qty | Rate | Estimated |
|---|---|---|---|---|
| HON-CIR | Surgeon fees | 1 | 540.00 | 540.00 |
| HON-ANE | Anaesthetist fees | 1 | 260.00 | 260.00 |
| HON-AYU | Assistant fees | 1 | 120.00 | 120.00 |
| QUI-SAL | Theatre use · 2 h | 2 | 190.00 | 380.00 |
| INS-LAP | Laparoscopy supplies | 1 | 350.00 | 350.00 |
| HOSP-DIA | Inpatient stay · 1 day | 1 | 190.00 | 190.00 |
← Swipe to see every column
Estimated
USD 1,840.00
Authorized in the letter of guarantee
USD 1,840.00
Gap
USD 0.00
The estimate matches the letter of guarantee line by line. It can be scheduled.
The AI codes the case against that agreement’s fee schedule. Billing decides.
Theatre with its kit, its team and its actual consumption
Every procedure carries the room, the team by role, the kit that belongs to it and what was actually used. The gap between kit and consumption is visible the same day, the lot about to expire is visible before it is opened, and fees per role come out of the same case.
- Kit per procedure, built from the scheduled surgery
- Actual consumption against the kit, with its reason
- Lots and expiry dates next to the item that will be used
- Shortages caught before the procedure, not during it
↓ Interactive · demo data
2 rooms · 3 procedures
Today’s theatre
Team by role
Surgeon
Dr. A. P.
Anaesthetist
Dra. M. C.
Assistant
Dr. J. T.
Scrub nurse
Lic. R. V.
Fees per role come out of this same case: they are not recalculated elsewhere.
Procedure kit vs actual consumption
- 10 mm trocarKit 2 · Used 3 (+1)
- 5 mm trocarKit 2 · Used 2
- Titanium clipsKit 6 · Used 6Lot L-2291 · expires this month
- Absorbable sutureKit 3 · Used 2 (-1)
- Sterile gauzeKit 10 · Used 8 (-2)
One 10 mm trocar above the kit: it is added to the case and enters the pre-invoice with its reason.
The AI builds the kit from the procedure and compares consumption. The surgical team closes the record.
Deductions answered inside the deadline
Receivables split by payer — insurer, corporate and self-pay — with their ageing, and the medical-audit queue where each observation carries its deadline in business days. The AI gathers the evidence that answers it and drafts the response; billing reviews, adjusts and sends.
- Ageing per payer, not one aggregate number
- Each deduction with its deadline in business days
- Evidence pulled from the case: report, operative note, consumption
- A deduction that is right is not fought: it is reclassified
↓ Interactive · demo data
Receivables by payer · deductions with a deadline
Collections from insurers
Ageing by payer (days)
- 0–30
- 31–60
- 61–90
- +90
- Aseguradora AltamarinsurerUSD 48,200.00
- Seguros VertienteinsurerUSD 31,750.00
- Mutual AlmenarainsurerUSD 22,480.00
- Convenios de empresacorporateUSD 14,920.00
- Particularesself-payUSD 6,310.00
Medical-audit deductions
Flagged line
INS-LAP · FAC-10482
Time left
6 business days
Evidence gathered by the AI
- Signed operative note
- Theatre consumption including the extra trocar
- Fee schedule in force on the day of the procedure
Draft response
We attach the actual consumption signed by the surgical team and the fee-schedule line in force on the date of the procedure, with the clinical reason for the additional supply as described in the operative note.
Answered with evidence inside the deadline.
Billing reviews and sendsThe AI gathers the evidence and drafts. The person is the one who answers the insurer.
WHAT THE SYSTEM DOES
Capabilities built for how a clinic actually runs
Each one lives where the work happens: admissions, consulting room, theatre, pharmacy and billing.
Authorization request assembled and sent
The case generates the request with the signed medical report and the declaration form, through the channel that insurer uses: portal, email or PDF.
Reading the answer and extracting the authorization
The answer arrives by email, attachment or portal. The AI reads it, extracts the authorization or letter of guarantee, links it to the case and keeps the original document as evidence.
Validity watched, rescheduling handled
Every letter of guarantee stores its validity according to the agreement. The system warns before it expires and flags the cases that must be requested again after a reschedule.
Fee schedule per insurer and plan
A single live table per agreement: consultation, inpatient stay, surgery, pharmacy and fees per role, each with its validity and its history.
Pre-surgical estimate against the letter of guarantee
The procedure becomes coded lines with amounts. What was estimated is compared with what was authorized, and the gap is written down before anyone operates.
Pre-billing with gaps flagged
Before issuing, each line is checked against the agreed fee schedule. Whatever does not match is held with the reason written out, instead of being discovered in a deduction.
Surgical kit and actual consumption
Kit per procedure, consumption recorded in theatre and the gap between them. Fees per role — surgeon, anaesthetist, assistant — come out of the same case.
Pharmacy with lots and expiry dates
Dispensing against a medical order, minimums per service, lots with their expiry date and stock-out alerts before a supply is missing in theatre.
Deductions answered with their evidence
Every medical-audit observation carries its deadline and its file: the AI gathers report, operative note and consumption, and drafts the response. Billing reviews and sends.
CONNECTED STACK
It connects to what your clinic already uses — even to what has no API
Most insurers expose no API: they work by portal, email and PDF. That is exactly where assisted reading belongs.
Claude · Anthropic
Certified partnerReads answers and supporting documents, codes against the fee schedule and drafts responses
Insurer portals
When there is no API: portal, email and PDF, with the original document kept as evidence
WhatsApp Business
Appointment, estimate and authorization status sent to the patient with approved templates
Lab and imaging
Orders and results through whichever channel your provider exposes, linked to the patient’s case
Make / n8n
Bridges to the clinical system or ERP already in production, without replacing it
Supabase
Database with permissions per site and per role, and a trace of who opened each record
LIVE SYSTEM · Clínicas Latitud
This is what it looks like inside an AI-operated system — and how it is governed.
This is not an animation: it is a demo company’s system with its modules, agents and rules. Follow the guide or browse freely.
System modules
- 01Admissions and codes
- 02Bed census
- 03Medical schedule
- 04Operating room and kits
- 05Pharmacy
- 06Adjustments and collections
Boosty Standard for Operating with AISimulated AI · demo data
THE SAME FACT · TWO COMPANIES
One authorization: the clinic requests it, the insurer decides it.
It is one fact with two numbers. The clinic owns the clinical report behind it; the insurer owns coverage and the decision. Neither rewrites the other’s part, and both see the same timestamp.
K-9018 · A-9050Clínicas Latitud · requests it
K-9018 · A-9050Seguros Latitud · decides it
Real screenshot of the system · demonstration data
B-O-O-S-T-Y METHODOLOGY
Four phases, one deliverable per phase, a single owner
We start with the agreement that hurts most and the rest opens up from there. The calendar is set in the assessment, with your team.
Discovery
We map the real flow: what each insurer asks for, through which channel, with which form, what validity applies and which deadlines run in business days.
Deliverable
Map of agreements, channels and deadlines per insurer
Architecture
Fee schedule per insurer and plan, permissions per site and per role, what the insurer sees and what never leaves the clinical case.
Deliverable
Data model, access matrix and the AI policy
Build & Train
Admissions and authorizations first; then fee schedule and pre-billing; then theatre, pharmacy and the response to deductions.
Deliverable
System in production block by block, with its audit trail
Adopt & Scale
We train admissions, billing, theatre staff and physicians on their own portal. New sites and new agreements come after that.
Deliverable
An autonomous team that opens a new site without us
B-O-O-S-T-Y METHODOLOGY
Four phases, one order, one owner per task
This is how an end-to-end implementation is chained: every bar is a concrete task, with the role that owns it, and the marker runs through the sequence. The calendar is set in the assessment, with your team and your timing.
F1
Discovery
F2
Architecture
F3
Build & Train
F4
Adopt & Scale
Frequently asked questions about the system for clinics
No, and that is the rule governing the whole system. The AI prepares administrative and operational work: it assembles the authorization request, reads the insurer’s answer, codes against the fee schedule, compares consumption with the kit, spots gaps before billing and drafts the response to a deduction. Diagnosis, indication, treatment plan and discharge are decided and signed by a physician. The system records who signed what, and when.
The record lives in the system and the physician writes it, by dictation if preferred: what is dictated ends up written, they review it and sign it. What goes out to the insurer is the medical report the authorization requires, not the full record. Every time a record is opened it is logged with user, time and case.
The case, not the whole patient: the medical report for the requested procedure, the declaration form, the fee-schedule lines and the supporting documents it asks for in order to audit. Clinical data unrelated to that case does not leave. When it requests an extra document, it is recorded who sent it and when.
That is the norm. Work happens through the channel that insurer does expose: its clinic portal, its email or the PDF it returns. The system leaves the request ready, sends it through that channel and reads the answer when it arrives, extracts the authorization and keeps the original document as evidence. If an API appears later, it plugs in without changing how your people work.
Wherever your clinic decides, under permissions per site and per role: admissions does not see clinical detail, the physician sees only their patients, the insurer only the case. The legal framework for health data varies by country and by type of institution, so hosting, retention and consent are defined in the assessment together with your legal counsel, not by default.
For several. Each site runs its own schedule, theatre, pharmacy and agreements, and management sees the consolidated network. A patient treated at two sites still has one record. Permissions are set per site: whoever works at one does not see the other’s operation unless assigned to it.
Not necessarily. If your clinical system works, it stays and we build on top of what it does not cover: authorizations, fee schedules, pre-billing and deductions, connected by API or by whatever bridge is needed. If what you have is spreadsheets and email, then the full system does get built. That is decided in the assessment, looking at what you already run.
That is defined in the assessment. It depends on how many agreements must be modelled, how many sites come in, which channel each insurer uses and whether there is a clinical system to live alongside. We leave the assessment with the scope written down, the order of the blocks and what would be measured in each. No invented ranges before looking at your operation.
A WORD FROM THE FOUNDER
“In a clinic, what gets lost is not the diagnosis. It is the authorization that arrived on Friday, in an inbox nobody opened.”
I have seen clinics with good physicians, good equipment and a good name postpone surgery because the letter of guarantee expired while the patient waited for a date. And I have seen billing fight a deduction against the clock, hunting for the operative note in a shared folder.
None of that is a clinical problem. It is a filing problem: the authorization in an inbox, the fee schedule in a file, consumption on a sheet and the evidence on somebody’s desk. AI belongs exactly there: reading what arrives, coding it against what was agreed and warning before it expires. Clinical work is untouched, and that is not a technical limitation: it is the system’s policy.
If your clinic bills several insurers and each one has its own agreement, book thirty minutes with me. Not with a salesperson. With me. We leave with the map of your agreements and with which block to build first.
Gabriel Montiel
CEO · Boosty Digital
GET STARTED
Ready for the authorization to stop living in an inbox?
Book a 30-minute assessment. We go through your agreements, each insurer’s channel and where deductions are piling up. We tell you what we would build first and how it would be measured.