PHI redaction layer
On-prem deterministic redactor for names, MRNs, dates, addresses. Reversible inside their VPC, never reversible at the model layer.
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Work/Healthcare · 12 facilities
Healthcare · 12 facilities · 2025
A 12-facility healthcare network was writing off $4M+ per year in unappealed insurance denials. We built a HIPAA-compliant agent that reads EOBs, drafts appeals, and routes to humans only when stakes are high.
18,000 denials per month from 40+ payers. A team of six revenue-cycle specialists could touch maybe 30% of them. The rest went to write-off — even when many were clearly recoverable. Two healthtech vendors had pitched them; both required uploading PHI to vendor cloud. Compliance killed both engagements.
We started with the compliance officer, not the CFO. Two weeks of architectural review with their HIPAA security team before we wrote a line of agent code. PHI never leaves their VPC, every model call is logged with redaction proofs, BAAs cover every vendor in the chain.
On-prem deterministic redactor for names, MRNs, dates, addresses. Reversible inside their VPC, never reversible at the model layer.
Claude classifies the EOB into 47 denial categories. Confidence-aware: low-confidence stays in human queue.
Templated appeal letters with case-specific evidence. RAG over their chart system.
Anything over $5K, soft-tissue, or litigious-payer routes to human review. Full audit trail.
HIPAA review, BAA negotiations, redaction layer.
Denial classifier, EOB parser, FHIR integration.
Two facilities, one payer. Human review on every appeal.
All 12 facilities, all payers.
Year 1, post-cutover. Tracking $2.9M annualized in months 6–12.
Down from 21 days. Critical for time-bound payer windows.
Across 380K processed denials. Compliance officer signs off monthly.
We tried three "AI partners" before this one. The difference: theirs has a runbook, an on-call rotation, and a roadmap. The others had decks.
30-minute discovery call. We'll tell you on the call which engagement model fits — or whether to keep your money.