Healthcare · Operations

Samso Industry Demo · Updated May 2026

Operations for Healthcare

Multi-site physician-group ops is the headline function - patient intake + insurance verification, prior auth + clinical documentation packaging, claims scrubbing + denial work, and records release across 312K LTM encounters. All extraction runs in HIPAA-aligned environments - BAA in place, PHI scoped to minimum-necessary fields, audit log on every prompt, no PHI in model fine-tuning data. Samso runs the back-office workflows that lets a 14-clinic group hit a 9.2% denial rate (target 6) and 96.8% extraction accuracy with leaner ops.

Function KPIs · how the operations org reads its own week

Hours reclaimed / week

148

+72 LTMAcross intake · prior auth · denial work · ROI

Doc extraction accuracy

96.8%

+2.8pp LTMFace sheets · EOBs · clinical notes · ABNs

Initial denial rate

9.2%

vs 6% targetEligibility + prior auth friction on 3 commercial payers

Prior auth turnaround

3.2 d

vs 2.0 d targetCardiology imaging + GI procedures driving the tail

Weekly hours reclaimed by managed workflow - last 12 weeks with cumulative overlay

WEEKLY · HRS / WK · STACKED BY WORKFLOW · CUMULATIVE HOURS OVERLAY · MOCK DATA · HIPAA-ALIGNED

03774111148HRS / WK1.4K74176CUM HRSW1W2W3W4W5W6W7W8W9W10W11W12

Revenue cycle workflows

Patient intake + insurance verification + benefits checkPrior auth + clinical documentation packagingClaims scrubbing + denial work + appeal drafting

Records + release of information

Records release + ROI requests + chart prep (HIPAA-tracked)

Twelve services · sized to healthcare

Each tile is what Samso runs in this function for a healthcare org.

01 · Service

Document Extraction Pipelines

Face sheets, EOBs, ABNs, prior-auth packets, and clinical notes parsed into structured fields - straight into PM/EHR with BAA + minimum-necessary PHI handling.

Docs / mo

5.8K

Accuracy

96.8%

Hours / wk

62

02 · Service

Project Management Tool Creation

Service-line builds, payer-contract rollouts, and clinic-opening workflows built on the existing PM stack - clinical, RCM, and ops all see status and risk.

Workflows live

14

Cycle time

−32%

03 · Service

Email Triage & Classification

Front-desk inbox, RCM inbox, and provider desk triaged into categories (referral, prior auth, records, denial) - routed with SLA timers, no PHI in subject metadata.

Emails / wk

4.2K

Auto-classified

94%

04 · Service

SOP Generation from Recordings

Front-desk + RCM SOPs drafted from huddle recordings and supervisor walk-throughs - patient identifiers stripped from transcripts before any model touches them.

SOPs / qtr

28

Update cadence

Quarterly

05 · Service

Cross-System Data Reconciliation

Daily recs across PM ↔ EHR ↔ clearinghouse ↔ GL ↔ payroll - break flags inside 15 minutes, charge-capture variance caught before close.

Recs managed

26

Break detection

15 min

Hours / wk

22

06 · Service

Internal Knowledge Base / RAG

RAG over payer policies, prior-auth criteria, CPT/ICD coding manuals, and clinical guidelines - corpus is PHI-free, sourced answers with citations for staff.

Documents

16K

Queries / wk

820

Citation rate

100%

07 · Service

Workflow Orchestration Builds

Prior auth → submission → appeal queues, referral intake, and ROI request flows orchestrated across systems - HIPAA audit-logged with role-based PHI access.

Flows live

12

Steps managed

208

08 · Service

Contract Review & Extraction

Payer contracts, vendor MSAs, and provider employment agreements parsed for rate schedules, cap rates, and key dates - flagged into RCM and finance.

Contracts / mo

120

Clauses tracked

580

09 · Service

Reporting Pipelines

Days in AR, denial rate, net collection, encounters, and HCAHPS - auto-generated from PM/EHR/clearinghouse for RCM, ops, and CFO.

Reports / mo

28

Auto-coverage

94%

10 · Service

Calendar & Scheduling Agents

Provider templates, clinic schedules, referring-PCP visits, and IME / external review scheduled across 14 clinics - conflict-aware, no PHI in calendar metadata.

Slots / wk

6.2K

No-show rate

8.4%

11 · Service

Audit & QA Automation

Internal QA over claim files, coding accuracy, and HIPAA access logs - sample selection, exception flags, and remediation tracker for OIG + payer-audit readiness.

Charts reviewed / mo

1.6K

Coding exception rate

2.8%

12 · Service

File Organization & Tagging

Patient charts, payer correspondence, contracts, and HR files tagged for retention, ROI, and audit ask - HIPAA retention enforced, access logged at file level.

Files tagged

240K

Retention compliance

100%

What you get · every week & every month

Concrete deliverables, not just dashboards.

Deliverable

Weekly hours-reclaimed report

Every Monday: hours reclaimed by workflow (intake, prior auth, denial work, ROI) with backlog status, denial-rate delta, and SLA breaches flagged for ops leadership.

Deliverable

Daily denial work-list

Top denials by payer, CPT, and provider - root-caused, owner assigned, appeal-letter draft pre-attached where the patient + clinical record support overturn.

Deliverable

Monthly HIPAA + audit-log review

Access logs, BAA status, role-based PHI access drift, and minimum-necessary review - refreshed monthly for compliance lead and quarterly for the board.

Deliverable

Always-on internal RAG (PHI-free corpus)

Payer policies, prior-auth criteria, coding manuals, and clinical guidelines searchable with citations - staff get sourced answers, no PHI in the corpus.

Healthcare · Operations

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