AI Patient Intake with Built-In Eligibility Check
An AI agent collects patient intake details in plain language, then runs a real-time insurance eligibility check through Stedi before check-in.
The workflow
The complete flow, exactly as it runs in the Workflow Builder. Scroll to explore, or use the zoom controls.
Requirements
Set up these connections in the Workflow Builder before importing or running this workflow.
Allows the AI agent to read patient context from Cerner when intake arrives as an HL7 appointment message rather than plain-language input.
The clearinghouse connection the agent calls to run the real-time X12 270/271 eligibility check once it has extracted the patient's insurance details.
About this workflow
What if a patient could just say — or type — when they want to come in and why, and the system handled the rest? This workflow uses an AI agent to collect intake details from a patient's own words, then runs a real-time insurance eligibility check before they ever reach the front desk.
The problem
Patient intake is a mess of forms, phone calls, and manual coverage checks. The information arrives in a dozen different shapes — a phone call, a portal form, an HL7 message — and someone still has to pull out the insurance details and verify them by hand. It's slow for staff and frustrating for patients.
How it works
However the patient arrives — describing their visit in plain language, submitting a portal form, or coming in as an HL7 appointment message — an AI agent reads the input and pulls out the details that matter: name, date of birth, and insurance member ID.
The agent then calls a real-time eligibility tool, which maps those details into the standard clearinghouse format and runs a live check through Stedi to the payer. Finally the agent summarizes the result in friendly language — is the plan active, and what are the key benefits — ready to show the patient and the provider.
Why it matters
Intake and insurance verification — usually two separate manual chores — happen together, automatically, from whatever the patient gives you. Staff start each visit already knowing coverage and benefits, and patients get a clear answer up front instead of a bill later.
Who it's for
Health systems modernizing patient intake and scheduling, and teams that want to combine conversational AI with real-time insurance checks in one flow.
How to build this workflow
Recreate it in the Workflow Builder by wiring these steps in order — or download it above and import it directly.
Step 1: Capture the Appointment
A booking comes in — a scheduling notification from the EHR, a patient-portal form, or an API call — carrying the patient and their insurance details.
Step 2: Pull Insurance Details
Read the patient's name, date of birth, and member ID out of whatever arrived.
Step 3: Build the Eligibility Request
Map those details into the standard electronic format insurers expect for a coverage check.
Step 4: Check With the Payer
Send the request through Stedi to the insurance payer in real time and get the coverage answer back.
Step 5: Read Back Coverage & Benefits
Turn the response into a clear report — active plan, copays, deductibles, out-of-pocket, and what's covered.
Step 6: Share With the Team
Return the result to the front desk or patient, and write it back to the health system.