Healthcare Operations · Enterprise AI Agents

Healthcare operations
run on rules your staff
should never have to execute manually.

Prior authorization protocols, payer eligibility rules, claims scrubbing requirements, and clinical documentation standards are all documented, known, and applied the same way every time. The friction is not complexity — it is volume and the absence of an execution layer that runs the rules without human involvement.
Healthcare operations staff absorb the execution layer: monitoring payer portals, chasing clinical documentation, reading denial codes, following up on aged AR. This is not where their expertise creates value. It is administrative execution that compounds with every additional payer, every additional procedure type, every additional patient.
PLRX builds specialist AI agents for healthcare operational workflows and the execution platform they run on. 94% of missions resolve without a human touchpoint — measured in production today against real payers, real providers, and real patients.

94% autonomous resolutionFrom $0.99 per missionEnterprise Agentic

Book a Scoping Call

See healthcare operations automated.

Tell us which healthcare workflow carries the most manual friction. Proof of concept in 2–3 weeks — production in 12 weeks.

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Current vs Autonomous Healthcare Operations

Current State

Prior authorization

Staff submits, monitors payer portals manually, chases documentation, resubmits. 3–5 touchpoints per authorization. Average cycle: 8–14 days.

Claim submission and denial

Claims scrubbed inconsistently. Denials enter queue, age 8–14 days before worked. First-pass acceptance: 75–85%. Timely filing losses: recurring.

Medical supply ordering

Staff manages documentation collection, eligibility checks, prior auth, and order submission manually. Multiple handoffs. Each step a queue entry.

AR follow-up

AR aging reviewed weekly. Claims approaching timely filing discovered late. Follow-up initiated when deadline pressure forces it.

Prior auth cycle: 8–14 days · First-pass acceptance: 75–85% · AR monitoring: weekly · Timely filing losses: recurring

With PLRX

Prior authorization

Agent submits, monitors continuously, requests documentation the same day as pend, resubmits the same day documentation arrives. Average cycle: 3–5 days.

Claim submission and denial

Every claim validated before submission. Every denial worked the day it arrives. First-pass acceptance: 95%+. Timely filing losses: eliminated for monitored denials.

Medical supply ordering

End-to-end mission: eligibility, documentation, prior auth, order submission — all specialist agents, continuous, no handoffs. 94% autonomous from referral to fulfilment.

AR follow-up

Every open claim monitored continuously. Follow-up at day 60. Escalation at day 75. Timely filing exposure eliminated for monitored claims.

Prior auth cycle: 3–5 days · First-pass acceptance: 95%+ · AR monitoring: continuous · Timely filing losses: eliminated

PLRX Specialist Agents — Healthcare Operations

What healthcare AI agents
handle in production.

Workflow	Specialist Agent	What Resolves Autonomously
Prior authorization	Prior Auth Specialist Agent	EDI 278 submission, payer portal monitoring, pend response, clinical documentation collection, resubmission, approval notification. Standard auth types end to end.
Eligibility verification	Eligibility Agent	EDI 270/271 checks before every submission. Coverage gap identification. Alternative coverage search. Results logged in workflow.
Clinical documentation collection	Clinical Documentation Specialist	SWO, CMN, F2F identification and request. Provider contact and follow-up. Completeness validation. Attachment to submission.
Claims scrubbing and submission	Billing Service Agent	NCCI edit validation, modifier correction, payer-specific rule application. Clearinghouse submission. Rejection handling and resubmission.
Denial management and appeal	Denial Management Agent	Reason code classification. Standard denial correction and resubmission. Appeal package assembly. Timely filing monitoring.
Medical supply ordering	Homecare Customer Support Agent + Billing Service Agent	End-to-end from referral: eligibility, documentation, prior auth, ML denial-risk scoring, order submission. 94% autonomous in production.

Healthcare Operations · The Compliance Question That Determines Deployment

Who can see what the agent did?

Healthcare AI agents touch PHI, submit to payers on behalf of patients, and generate clinical and billing records that carry regulatory weight. Every action must be logged, timestamped, and queryable — for payer audits, HIPAA compliance reviews, and billing compliance examinations.

PLRX logs every agent action in real time. Every eligibility check, every prior auth submission, every documentation request, every claim correction, every denial worked — captured in a WORM-locked, immutable audit trail. Queryable by patient, by payer, by claim number, by workflow type. Retrievable without vendor involvement.

PHI handling is architectural: field-level AES-256-GCM encryption, sovereign per-tenant environment, no shared data plane. BAA available before any PHI is processed. The compliance architecture is not a tier upgrade — it is the baseline for every PLRX healthcare deployment.