How Next Health AI Actually Works

Advanced AI automation that integrates directly with your EHR workbench to eliminate revenue cycle backlogs at scale.

The 5-Step Workflow

Every encounter flows through our AI pipeline, with human review at critical decision points.

1
Encounter Complete
Physician closes note in EHR
2
AI Chart Review
AI scans for missing elements
3
Intelligent Routing
Auto-clear or route to CDI/coder
4
Human Review
Coder validates AI suggestions
5
Clean Claim
Submitted to payer in 48 hours

5 AI Interventions

Each intervention targets a specific bottleneck in the EHR workbench workflow.

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1. Automated Chart Review

Our AI reads every clinical encounter and identifies missing documentation elements required for clean claims submission.

How it works: Scans for compliant chief complaint, complete HPI, appropriate ROS, physical exam matching E&M level, MDM documentation, ICD-10 support, medical necessity, and payer-specific requirements.

15 min β†’ 2 min per chart
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2. CDI Query Generation

Auto-generates professional queries to physicians when documentation gaps are identified, complete with clinical citations.

How it works: Cites specific documentation, lists clinical indicators present, asks open-ended questions, provides response options, and explains coding/reimbursement impact.

30 min β†’ 5 min per query
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3. Code Suggestion

Suggests ICD-10 and CPT codes based on documentation with supporting text quotes and confidence levels.

How it works: Extracts diagnoses and procedures, suggests codes with specificity, identifies primary vs secondary, suggests E&M level, flags missing documentation for higher codes, and checks for edit-triggering combinations.

20 min β†’ 5 min per encounter
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4. Edit Resolution

When claims fail internal edits, our AI searches the chart for required elements and either auto-clears or drafts physician queries.

How it works: Analyzes edit failure reason, searches clinical documentation for supporting evidence, determines if documentation supports the code, and either auto-fixes or routes for physician query.

60-70% auto-cleared
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5. Prior Auth Documentation

Generates clinical narratives for prior authorization requests, citing guidelines and payer requirements.

How it works: Summarizes clinical presentation, documents conservative treatments attempted, explains medical necessity, cites clinical guidelines, and formats per payer requirements.

2 hrs β†’ 15 min per auth
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Real-Time Dashboards

Executive dashboards show work order aging, bottleneck identification, A/R trending, and ROI achievement vs projection.

How it works: Pulls directly from EHR data warehouse, updates daily for work orders and A/R, weekly for clean claims rate, and monthly for denials and ROI tracking.

100% transparency

Technical Architecture

Built on advanced language models with enterprise-grade security and major EHR integration.

// Example: Automated Chart Review async function reviewEncounter(encounterId) { // Pull encounter data from EHR const encounter = await EHR_API.getEncounter(encounterId); // Send to AI for analysis const analysis = await NHAI_API.analyze({ model: "nhai-llm-v4", prompt: `Review this encounter for missing elements: Type: ${encounter.type} Payer: ${encounter.payer} Documentation: ${encounter.note} Check for: HPI, ROS, Physical Exam, MDM, ICD-10 support` }); // Route based on findings if (analysis.missing.length === 0) { return autoClearWorkOrder(encounterId); } else { return routeToCDI(encounterId, analysis.missing); } } // Result: 15 minutes β†’ 2 minutes per chart // Human validates final decision

Human-in-the-Loop Design

Our AI suggests, humans approve. This is critical for compliance, quality control, and staff buy-in. Coders don't feel replacedβ€”they feel empowered by efficiency.

Enterprise Integrations

Seamless integration with your existing EHR infrastructure and payer systems.

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Epic Systems

Workbench, Resolute, CDI, HIM

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Cerner

Revenue Cycle Management

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Clearinghouses

Change Healthcare, Waystar

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Payer Portals

UHC, Aetna, Anthem, Medicare

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HIPAA Compliant
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SOC 2 Type II
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End-to-End Encryption
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BAA Agreements

Our AI Technology

Built on state-of-the-art language models optimized for healthcare applications.

Capability Why It Matters Our Advantage
200K Token Context Can read entire patient chart + encounter history βœ“ Longest context window available
Low Hallucination Rate Critical for healthcare - can't make up clinical facts βœ“ Says "I don't know" vs fabricating
Instruction Following Must follow complex health system protocols exactly βœ“ Best-in-class for complex instructions
Writing Quality CDI queries must be professional, physician-appropriate βœ“ Natural language generation
API Reliability 99.9% uptime required for revenue cycle operations βœ“ Enterprise SLA guarantees
Privacy & Security PHI handling requires HIPAA compliance βœ“ Zero data retention, BAA available

Ready to See It in Action?

Schedule a technical demo and we'll show you the exact workflow with your EHR system.