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
4
insurers
each with its own agreement, fee schedule and deadlines
5
role-based portals
admissions · physician · OR · billing · patient
1
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.
WHERE ORDER STARTS
Five points in a clinic’s administrative circuit that gain an owner and traceability
Your medical team makes the clinical calls. The administrative side — authorizations, letters of guarantee, fee schedules, deductions and supplies — can run in one system, with the AI preparing the paperwork and a person signing whatever commits a patient or money.
Every authorization, read from the reply and attached to the case
Today admissions sends the report and the form through each insurer’s channel, and the answer comes back as a PDF, an email or a note inside the portal. Someone has to open it and copy the authorization into the case; if nobody does, admission or surgery gets complicated that same day. In the system, the AI reads the reply, extracts the authorization and attaches it to the case.
The validity of every letter of guarantee, watched
Today the letter expires according to each insurer’s agreement — in one agreement, fifteen business days, thirty for maternity — and a rescheduling means requesting it again. The expiry is discovered when the insurer rejects the invoice. In the system, each letter carries its date and the alert goes out before it expires.
One fee schedule per insurer and plan, applied when estimating
Today each agreed table — consultation, inpatient stay, surgery, pharmacy, professional fees per role — lives in a file, and whoever builds the estimate opens the one they believe applies. The gap shows up with the deduction. In the system, the estimate is built against the fee schedule of the patient’s plan.
Every deduction answered with its evidence, on time
Today the medical audit questions a line and asks for the report, the operative note, pharmacy consumption and the surgeon’s signature, and collecting them takes days while the clock runs in business days. In the system, the evidence already hangs from the case and the answer is built from it, with the deadline in view.
Operating room and pharmacy inside the same case
Today the procedure kit, actual consumption and lot numbers with their expiry sit on three different sheets, and what was used in theatre is not matched to what was billed. In the system, consumption is recorded against the case’s kit and every lot carries its expiry in view.
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.
Users
Attending physicians and specialists
Access to
Only their patients: record, orders, medical report and operative note.
Sees on screen
The day’s schedule, the record with dictated notes already written down, the report for the authorization in draft and a sign button. Nothing reaches the insurer without that signature.
Users
Theatre coordination, scrub staff and clinical pharmacy
Access to
Room scheduling, kit per procedure, consumption, lots and expiry dates.
Sees on screen
Theatre by room and time with its team, the kit suggested against the procedure, actual consumption versus kit, lots about to expire and shortages caught before the procedure.
Users
Billing, insurance and collections
Access to
Fee schedules per insurer and plan, expense statements, deductions and account statements.
Sees on screen
A pre-invoice with every fee-schedule gap flagged before issuing, deductions with their deadline and a response already assembled with supporting documents, receivables by payer and by site.
Users
Patients and authorized family members
Access to
Only their case: appointments, estimate, authorization status and released results.
Sees on screen
Where their authorization stands without internal jargon, the estimate showing what the plan covers and what is out of pocket, and their results once the physician releases them.
Admissions portal
Today’s authorizations by status
Admissions works with coverage and paperwork. Clinical detail is not on this screen.
Physician portal
Record and report signature
OR and pharmacy portal
Kit, lots and shortages
Shortages appear before the procedure, not during it.
Billing and insurance portal
Pre-invoice against the fee schedule
Patient portal
Their case, without internal jargon
Results appear here once the physician releases them.
EXPLORE THE SYSTEM
Four modules, clickable before we talk
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 AI assembles the request
Medical report and declaration form as that agreement requires. Anything missing is flagged before sending.
Requirements in the agreement
- Medical report with diagnosis and indication
- Declaration form for the agreement
- Policyholder and patient identification
- Estimate by fee-schedule lines
- Weight and height in the report (this agreement asks for them)· Missing before sending
The medical report does not go out without the attending physician’s signature.
Sent through the insurer’s channel
Clinic portal, email or PDF — whichever channel that insurer exposes. The receipt is kept.
salud.solicitarClave(HC-5177)
→ canal: portal de clínicas · Altamar
→ adjuntos: informe_firmado.pdf · planilla.pdf
✓ acuse recibido · 09:41
waiting for the insurer’s answer…
The AI reads the answer
A PDF arrives. The AI extracts the key, the validity and the authorized amount, and cross-checks them against the case.
Extracted from the answer
- Authorization key
- CLV-88214
- Validity
- 15 business days (per agreement)
- Authorized amount
- USD 1,840.00
- Condition
- Plan co-payment payable by the patient
Matches the case
- Patient identification
- Requested procedure
- Scheduled date
Original document kept as evidence
Linked to the case and watched
The letter of guarantee stays on the case with its validity. If the patient is rescheduled, the system asks for a new request.
Validity watch
CLV-88214- Alert three business days before it expires, to the person who owns the case.
- If the procedure is rescheduled past the validity, the case reopens the request.
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.
| Code | Fee-schedule line | Qty | Rate | Estimated |
|---|---|---|---|---|
| HON-CIR | Surgeon fees | 1 | 510.00 | 510.00 |
| HON-ANE | Anaesthetist fees | 1 | 250.00 | 250.00 |
| HON-AYU | Assistant fees | 1 | 115.00 | 115.00 |
| QUI-SAL | Theatre use · 2 h | 2 | 200.00 | 400.00 |
| INS-LAP | Laparoscopy suppliesabove schedule | 1 | 485.00 | 485.00 |
| HOSP-DIA | Inpatient stay · 1 day | 1 | 155.00 | 155.00 |
← Swipe to see every column
Estimated
USD 1,915.00
Authorized in the letter of guarantee
USD 1,760.00
Gap
USD 155.00
INS-LAP came in above the agreed fee schedule. The gap is settled now: either the line is corrected or an extension of the letter of guarantee is requested.
| Code | Fee-schedule line | Qty | Rate | Estimated |
|---|---|---|---|---|
| HON-CIR | Surgeon fees | 1 | 495.00 | 495.00 |
| HON-ANE | Anaesthetist fees | 1 | 240.00 | 240.00 |
| HON-AYU | Assistant feesnot covered | 1 | 110.00 | 110.00 |
| QUI-SAL | Theatre use · 2 h | 2 | 185.00 | 370.00 |
| INS-LAP | Laparoscopy supplies | 1 | 325.00 | 325.00 |
| HOSP-DIA | Inpatient stay · 1 day | 1 | 150.00 | 150.00 |
← Swipe to see every column
Estimated
USD 1,690.00
Authorized in the letter of guarantee
USD 1,580.00
Gap
USD 110.00
This agreement does not cover assistant fees. It is written into the patient’s estimate before surgery, not after.
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.
Team by role
Surgeon
Dr. E. L.
Anaesthetist
Dra. M. C.
Scrub nurse
Lic. P. O.
Fees per role come out of this same case: they are not recalculated elsewhere.
Procedure kit vs actual consumption
- Arthroscopic cannulaKit 2 · Used 2
- Disposable burrKit 1 · Used 1
- Irrigation solution 3 LKit 4 · Used 5 (+1)
- Elastic bandageKit 2 · Used 2
One irrigation solution unit is short in the site pharmacy: pharmacy sees it before the procedure, not during.
Team by role
Surgeon
Dr. A. P.
Anaesthetist
Dr. S. B.
Scrub nurse
Lic. R. V.
Fees per role come out of this same case: they are not recalculated elsewhere.
Procedure kit vs actual consumption
- Polypropylene meshKit 1 · Used 1Lot L-3410
- Non-absorbable sutureKit 4 · Used 4
- Local anaestheticKit 2 · Used 2
- Sterile gauzeKit 10 · Used 9 (-1)
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 reclassified and billed where it belongs
↓ 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 sendsFlagged line
HOSP-DIA · FAC-10391
Time left
2 business days
Evidence gathered by the AI
- Medical order for admission
- 24-hour progress note
- Discharge time recorded on the case
Draft response
We submit the signed admission order, the progress note and the recorded discharge time, which support the day billed.
Two business days left: the case moves to the top of the queue.
Billing reviews and sendsFlagged line
HON-AYU · FAC-10377
Time left
9 business days
Evidence gathered by the AI
- Estimate signed by the patient before surgery
- Letter of guarantee with the authorized lines
Draft response
The observation is not disputed: the line is reclassified to the patient, who had it written in the estimate signed before surgery.
This one is reclassified and billed where it belongs.
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
Claude 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.
A demo company’s system, with its modules, agents and rules at work. 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 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
Assessment
F2
Architecture
F3
Build
F4
Adoption
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, the diagnosis belongs to the physician. The authorization that arrives by email belongs to the system: read and attached to the case.”
A clinic runs on two clocks: the clinical one, kept by the physician, and the administrative one, set by the letter of guarantee, the fee schedule and the deduction deadline. When the second clock is kept in inboxes and spreadsheets, surgery gets postponed because the letter of guarantee expired while the patient waited for a date, and billing answers a deduction against the clock, hunting for the operative note in a shared folder.
AI works on the administrative clock: it reads the authorization that arrives, codes it against what was agreed with each insurer, gathers consumption and supporting documents in the file and warns before anything expires. The physician decides the clinical, and that is written into the system’s policy.
For the clinic, that means one file per case with the authorization, fee schedule, consumption and supporting documents in the same place. Book thirty minutes with me: we leave with the map of your agreements and which block to build first. How many different agreements does your clinic bill against today?
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.