AI-Powered FHIR Billing & Eligibility Automation for Clinics

This consulting service enables healthcare organizations—particularly dental and outpatient clinics—to transform revenue cycle operations using Azure cloud and AI technologies. Built on Azure Health Data Services, the platform ingests and manages FHIR resources such as Patient, Coverage, Claim, and Task.

The system uses Azure Communication Services to automate calls to payers, including real-time voice interactions for:

• Eligibility checks (fallback when clearinghouse data is incomplete)
• Claim status follow-ups
• Pre-authorization criteria verification
• Escalations for unresolved workflows

AI services (OpenAI real-time API or Azure OpenAI) are triggered via FHIR Task resources, ensuring event-driven, auditable execution. These services automate form filling, denial explanation, code recommendations, and patient communication generation.

Business Benefits

• Automates up to 70% of billing workflows
• Accelerates insurance response cycles
• Reduces claim denials via accurate pre-submission checks
• Uses industry-standard FHIR for interoperability and compliance
• AI calling reduces time spent on payer IVR systems