We are a multi-hospital healthcare network that partnered with Viston to reduce claim denials, speed up prior authorizations, and improve patient support without compromising PHI security.

Business challenge

Claim denial rate at 12.8%, long prior authorization cycles (72 hours median), and 27% of patient inquiries waiting over 10 minutes for resolution.

Contact center average handle time was 8.6 minutes with inconsistent documentation quality.

Our approach and solution

Viston conducted a HIPAA-first data audit, signed a BAA, and deployed an isolated Azure tenant with PHI redaction and FHIR-first integrations.

Delivered three workstreams:

Medical Coding Copilot with RAG over payer rules, ICD-10/HCPCS, and our historical approvals.

Prior-Auth Summarizer that compiles clinical notes and guidelines into payer-ready packets.

Patient Support Assistant for scheduling, benefits eligibility, and prep instructions, escalated via human-in-the-loop.

AI applications and benefits delivered

NLP/RAG for clinical summarization, denial reason prediction, and intent classification in patient queries.

Benefits: fewer denials, faster authorizations, 24/7 triage with safe handoffs, and improved documentation consistency.

Cost of implementation

USD 165,000 inclusive of cloud, licenses, security hardening, and 6 months of MLOps support.

Time to implement

14 weeks to pilot, 10 weeks to scale across 3 hospitals.

Tools and technologies used

Azure OpenAI (GPT-4 class), Azure Cognitive Search, FHIR server, Databricks, LangChain, n8n for workflow automation, Power BI, Key Vault, Private Link.

Quantitative outcomes

Claim denial rate reduced by 31% (to 8.8%).

Prior-auth median cycle time reduced by 46% (to 39 hours).

Contact center deflection of routine queries: 38%.

Average handle time reduced by 27% (to 6.3 minutes).

3.2x ROI within 10 months.

Key performance indicators (KPIs) tracked

Denial rate, prior-auth turnaround time, AHT, first-contact resolution, CSAT, PHI leakage incidents, model accuracy on medical intents.

Pre- and post-implementation metrics

Denials: 12.8% → 8.8%.

Prior-auth time: 72h → 39h.

AHT: 8.6m → 6.3m.

CSAT: 4.1/5 → 4.5/5.

Stakeholder quotes or testimonials

“Viston gave our teams superpowers while meeting our HIPAA bar. The coding copilot alone paid for itself in under a year.” — VP, Revenue Cycle

Regulatory or compliance considerations

HIPAA, SOC 2 Type II, BAA in place, PHI redaction, audit logging, least-privilege access, model governance with prompt/response retention policies.